Hydraulically controlled arterial/venous access

ABSTRACT

Apparatus and methods for hydraulically controlled arterial/venous access are provided. The apparatus and methods may include tubing anastomized to a conduit. A clamp may be positioned over the tubing. The clamp may seal the tubing. The clamp may be configured to unseal the tubing. The clamp may be positioned to seal the tubing such that outer walls of the tubing are compressed flush with each other. The tubing may include an inner lumen and an outer lumen. The outer lumen may terminate in a balloon. The inner lumen may include a compressible portion near the anastomosis site. The inner lumen may include a non-compressible portion. The balloon may encircle at least part of the non-compressible portion. A reservoir may be configured to control an opening or closing of the clamp. When the inner lumen is open, fluid may flow from the conduit to the reservoir.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a nonprovisional of U.S. Provisional Application No.61/788,962, filed on Mar. 15, 2013 which is hereby incorporated byreference in its entirety.

FIELD OF TECHNOLOGY

Aspects of the invention relate to a hydraulically controlled port foraccessing a blood vessel.

BACKGROUND

Various therapeutic treatments require access to blood flowing through acirculatory system. For example, treatments in the fields of hematology,oncology and/or pharmacology may require direct access to circulatingblood. Some treatments, such as dialysis, require an extraction andreintroduction of blood. The blood extracted from the body is filtered,waste products are removed and the filtered and “clean” blood isreintroduced into the circulatory system.

To perform dialysis, it is necessary to have access to the blood.Additionally, the access to the blood should provide a high extractionthroughput or flow rate. The flow rate allows a sufficient amount ofblood to be extracted within a given period of time. Efficacy of thedialysis procedure may be dependent upon the extraction throughput.

When performing dialysis, one method of accessing the blood is via anintravenous catheter. The catheter may be inserted into a large vein.Large veins, such as the vena cava, jugular vein or femoral vein, allowfor a higher extraction throughput than do other veins.

However, a catheter is a foreign body in the vein, and may triggervenous stenosis in the vein wall. The venous stenosis may scar andocclude the vein. As a result of the stenosis and occlusion, multipleaccess sites must be utilized and a patient on long term dialysis may“run out” of usable veins for catheter access. In addition, a cathetermay protrude out of a patient's skin and staving off infection is acommon challenge when employing catheter access. However, the patientmay desire catheter access because, after insertion, accessing thepatient's blood through connection of the catheter to a dialysis machinedoes not require repeated needle pricks.

Another access method is to surgically form an arteriovenous (“AV”)fistula. To form the fistula, a surgeon joins an artery to a vein,bypassing narrow capillaries. Arteries carry blood away from the heartand blood typically flows faster, and at a higher pressure, througharteries than veins. By transferring directly from an artery to a veinwithout intervening capillaries, blood flows swiftly from the arteryinto the vein. A fistula may be formed using an anastomosis, and maytake 4-6 weeks to mature.

After maturity, two needles are inserted into the vein distal to thecreated fistula. A first needle extracts blood which is transferred to adialysis machine. A second needle receives the filtered blood from thedialysis machine and reintroduces the filtered blood into the vein.

A fistula is characterized by lower infection rates than catheteraccess. However, because the fistula is always “on” and blood is alwaysflowing through the fistula, the fistula may stimulate a “stealsyndrome.” The steal syndrome occurs when insufficient blood flowreaches the bypassed capillaries. Blood may be drawn through the fistulaand returned to general circulation through the vein, preventingadequate blood flow to extremities of a limb. The steal syndrome mayresult in coldness in the extremities and tissue damage if severe.

A fistula may also be associated with development of an aneurysm in thevein. While undergoing dialysis, needles must be regularly inserted intoveins distal to the fistula to extract and return blood. The regularneedle insertions may weaken a wall of the vein, increasing a likelihoodof an aneurysm.

Another dialysis access method is to create an AV graft. The graftoperates under principles similar to the fistula. The graft creates anartificial conduit that transfers blood flow from an artery directlyinto a vein. Unlike the fistula, the graft joins the artery and veinusing a synthetic material. A graft typically matures faster than afistula, and may be used in cases where a patient's anatomy is notoptimal for creation of a fistula. The graft may be made of a lengthsufficient to join two blood vessels distant from each other.

However, grafts are associated with a higher rate of thrombosis. Thethrombosis may result from stenosis within arteries and veins adjacentto the anastomoses. Grafts are also typically associated with a higherrate of infection than the fistula. Furthermore, like a fistula, a graftcannot be turned “off,” and even after completion of a dialysisprocedure, blood is constantly flowing through the graft.

It would be desirable to obtain benefits of a fistula/graft withoutassociated disadvantages. It would be desirable to provide blood accessthat is associated with a high throughput and that may be “turned off”after a treatment. It would be desirable to provide regular access toblood without damaging a blood vessel as a result of repeated needlepricks. Therefore, it would be desirable to provide apparatus andmethods for a hydraulic port for accessing a blood vessel.

BRIEF DESCRIPTION OF THE DRAWINGS

The objects and advantages of the invention will be apparent uponconsideration of the following detailed description, taken inconjunction with the accompanying drawings, in which like referencecharacters refer to like parts throughout, and in which:

FIG. 1 shows an illustrative therapeutic scenario in accordance withprinciples of the invention;

FIG. 2 shows illustrative apparatus in accordance with principles of theinvention;

FIG. 3A shows illustrative apparatus in accordance with principles ofthe invention;

FIG. 3B shows illustrative apparatus in accordance with principles ofthe invention;

FIG. 4 shows illustrative apparatus in accordance with principles of theinvention;

FIG. 5A shows illustrative apparatus in accordance with principles ofthe invention;

FIG. 5B shows illustrative apparatus in accordance with principles ofthe invention;

FIG. 5C shows illustrative apparatus in accordance with principles ofthe invention;

FIG. 5D shows illustrative apparatus in accordance with principles ofthe invention;

FIG. 5E shows illustrative apparatus in accordance with principles ofthe invention;

FIG. 5F shows illustrative apparatus in accordance with principles ofthe invention;

FIG. 5G shows illustrative therapeutic scenarios and associatedapparatus in accordance with principles of the invention;

FIG. 6A shows illustrative apparatus in accordance with principles ofthe invention;

FIG. 6B shows illustrative apparatus in accordance with principles ofthe invention;

FIG. 7 shows illustrative apparatus in accordance with principles of theinvention;

FIG. 8 shows illustrative apparatus in accordance with principles of theinvention;

FIG. 9 shows an illustrative process in accordance with principles ofthe invention;

FIG. 10 shows an illustrative process in accordance with principles ofthe invention;

FIG. 11 shows an illustrative therapeutic scenario and associatedapparatus in accordance with principles of the invention;

FIG. 12 shows an illustrative therapeutic scenario and associatedapparatus in accordance with principles of the invention;

FIG. 13A shows an illustrative therapeutic scenario and associatedapparatus in accordance with principles of the invention;

FIG. 13B shows illustrative apparatus in accordance with principles ofthe invention;

FIG. 13C shows a partial magnified view of an illustrative apparatus inaccordance with principles of the invention, as indicated thereon;

FIG. 14 shows an illustrative therapeutic scenario and associatedapparatus in accordance with principles of the invention;

FIG. 15A shows an illustrative therapeutic scenario and associatedapparatus in accordance with principles of the invention;

FIG. 15B shows illustrative apparatus in accordance with principles ofthe invention;

FIG. 16 shows illustrative apparatus in accordance with principles ofthe invention;

FIG. 17 shows illustrative apparatus in accordance with principles ofthe invention;

FIG. 18 shows illustrative apparatus in accordance with principles ofthe invention;

FIG. 19 shows illustrative apparatus in accordance with principles ofthe invention;

FIG. 20 shows an illustrative therapeutic scenario and associatedapparatus in accordance with principles of the invention;

FIG. 21 shows an illustrative therapeutic scenario and associatedapparatus in accordance with principles of the invention;

FIGS. 22A-22C show an illustrative therapeutic scenario and associatedapparatus in accordance with principles of the invention; and

FIGS. 23A-23B show an illustrative process in accordance with principlesof the invention.

DETAILED DESCRIPTION OF THE DISCLOSURE

Apparatus and methods for a hydraulic access port are provided.

Apparatus may include, and methods may involve, a transport system. Thetransport system may include a port. The port may be coupled to a bloodvessel. The blood vessel may be an artery. The blood vessel may be avein. The blood vessel may be any suitable blood vessel. The port may becoupled to any suitable conduit carrying a medium.

The port may include an expandable chamber. The port may include arotatable swing-arm. The port may include a sealable passageway. Theport may include an orifice. The orifice may allow blood to flow betweenthe blood vessel and the port.

The transport system may include tubing. The tubing may be coupled tothe port. The tubing may include a first lumen. The tubing may include asecond lumen. The second lumen may be in fluid connection with theexpandable chamber. The second lumen may be expandable. The second lumenmay be oriented inferiorly with respect to the first lumen. Expansion ofthe second lumen may be configured to collapse the first lumen.Expansion of the second lumen may be configured to seal the first lumen.

The transport system may include a reservoir. The reservoir may becoupled to the tubing. The reservoir may be coupled to the port. Thereservoir may include a first collapsible chamber. The first collapsiblechamber may be coupled to the sealable passageway of the port. The firstcollapsible chamber may be capped with a first membrane.

The reservoir may include a second chamber. The second chamber may be influid connection with the second lumen. The second chamber may be influid connection with the expandable chamber of the port. The secondchamber may be capped with the first membrane. The second chamber may becapped with a second membrane.

The port may include a swing-arm. An injection of a medium into thesecond chamber may be configured to articulate the swing-arm. Movementof the swing-arm may seal the sealable passageway of the port. Theinjection of the medium into the second chamber may position theswing-arm over an orifice in the port. Expansion of the expandablechamber of the port may position the swing-arm over the orifice. Theposition of the swing-arm may be maintained by a pressure in thetransport system. The pressure may be maintained, at least in part, bythe first and/or second membranes.

The transport system may be a first transport system. Apparatus mayinclude, and methods may involve, a first transport system and a secondtransport system. The first transport system may be coupled to a firstblood vessel. The second transport system may be coupled to a secondblood vessel.

Apparatus may include, and methods may involve, a tubing. The tubing mayinclude a first end coupled to a blood vessel. The tubing may include asecond end. The second end may be coupled to a subcutaneous reservoir.The tubing may include a first sealable lumen. The first sealable lumenmay be configured to transport blood. The tubing may include a secondexpandable lumen configured to seal the first lumen.

Apparatus may include, and methods may involve, a transport system. Thetransport system may include a subcutaneous central reservoir. Thesubcutaneous central reservoir may include a first chamber. The firstchamber may be in fluid connection with a lumen of a first tubing. Thefirst chamber may be in fluid connection with a first lumen of a secondtubing.

The subcutaneous central reservoir may include a second chamber. Thesecond chamber may be coupled to a second lumen of the first tubing.

The subcutaneous central reservoir may include a third chamber. Thethird chamber may be coupled to a second lumen end of the second tubing.

The transport system may include a first port. The first port may becoupled to the first lumen of the first tubing. The first port may becoupled to the second lumen of the first tubing.

The transport system may include a second port. The second port may becoupled to the first lumen of the second tubing. The second port may becoupled to the second lumen of the second tubing.

Apparatus may include, and methods may involve, a transport system. Thetransport system may include a reservoir. The reservoir may include afirst chamber. The first chamber may be collapsible and expandable. Thereservoir may include a second chamber. The second chamber may becollapsible and expandable.

The transport system may include tubing. The tubing may be coupled tothe reservoir using a barb or adapter. The tubing may include a firstlumen. The first lumen may link the first chamber to a fluid carryingconduit. The conduit may be a blood vessel. The blood vessel may beanastomized to the tubing.

The tubing may include a second lumen. The second lumen may link thesecond chamber to a balloon. The second lumen may terminate at theballoon. The second lumen may be in fluid communication with theballoon. The balloon may encircle the first lumen. The balloon mayencircle a portion of the first lumen. The balloon may encircle aportion of the tubing that does not compress or deform when the balloonis inflated.

The system may include a clamp. The clamp may be coupled to the tubing.The clamp may be rotatably coupled to the tubing. The clamp may beconfigured to rotate about a pivot affixed to the tubing.

The clamp may expand about the first lumen in response to inflation ofthe balloon. The inflation of the balloon may overcome a force biasingthe clamp in a closed position. The clamp may compress the first lumenin response to deflation of the balloon. The clamp may compress asection of the first lumen. The clamp may compress the first lumen in aclosed position.

Compressing the first lumen may seal the system from the conduit andfluid flowing through the conduit. Compressing the first lumen may allowfluid carried through the conduit to flow without being impeded by thetubing.

The reservoir may include a septum. The septum may include aself-sealing membrane. The reservoir may include a moveable platform.The moveable platform may be disposed between a first chamber and asecond chamber of the reservoir.

The reservoir may include a biasing member. The biasing member may be aspring or any suitable pressure source. The biasing member may bias themoveable platform toward the septum. In some embodiments, the biasingmember may bias the moveable platform to press against the septum.

The reservoir may include a bladder. The bladder may reside within thesecond chamber of the reservoir. The bladder may be in fluidcommunication with the balloon. The second lumen may provide fluidcommunication between the bladder and the balloon.

Pressure may be applied to the moveable platform. A needle may beinserted into the reservoir through the septum. A tip of the needle mayexert pressure on the moveable platform. The pressure may push down onthe moveable platform. The moveable platform may include a slopingsurface to direct the needle to a center of the platform. The movableplatform may be flat, convex, concave or have any suitable surface. Inresponse to the pressure, the moveable platform may compress thebladder. Compressing the bladder may inflate the balloon with fluidtransferred from the bladder to the balloon via the second lumen.

The transport system may include a locking mechanism. The lockingmechanism may engage when the moveable platform is moved apre-determined distance away from the septum. After moving thepre-determined distance, a protrusion coupled to the platform may beseated into a well of the locking mechanism. Seating the protrusion inthe well may prevent the biasing member of the reservoir from moving theplatform toward the septum.

Seating the protrusion in the well may lock the moveable platform in aposition that maintains compression of the bladder and correspondinginflation of the balloon. The locking mechanism may be disengaged whenthe moveable platform is moved the pre-determined distance from theseptum. The platform may be moved by applying pressure to the platform.Moving the platform the pre-determined distance may shift the protrusionout of the well.

The well may be a relatively deep well. Pressure applied to the platformmay press the protrusion against a guide. The guide may direct theprotrusion into a shallow well. When in the shallow well, the platformmay allow fluid expelled by compressing the bladder to reenter thebladder. Deflation of the balloon may exert pressure that pushes fluidout of the balloon into the bladder.

The second distance may be equal to the first distance. The seconddistance may be greater than the first distance. The second distance maybe less than the first distance.

Tubing may include an inflexible portion. The inflexible portion mayextend along a first segment of the first lumen. In some embodiments thefirst segment of the first lumen may correspond to a segment of thefirst lumen that passes through the second lumen.

The first lumen may include a flexible portion. The flexible portion mayextend along a second segment of the first lumen. The second segment ofthe first lumen may include a segment of the first lumen between theballoon and a junction of the first lumen and the conduit.

The flexible portion of the tubing may include a flared end. The flaredend may be configured to be anastomized to the conduit. For example,when the conduit is a blood vessel, the flared end may be sutured,stapled or hooked onto the blood vessel.

The clamp may be biased to compress the flexible portion of the tubing.Compressing the flexible portion of the tubing may prevent fluid flowingthrough the conduit from entering the first lumen. Compressing theflexible portion of the tubing may allow fluid to flow through theconduit unimpeded by the first lumen.

Inflating the balloon may overcome the biasing force applied to theclamp. Overcoming the biasing force may open the first lumen to fluidflowing through the conduit. Deflating the balloon may allow the clampto fluidly seal the first lumen from the conduit.

In some embodiments the clamp may be biased in an open position. Theballoon may be positioned around an outside of the clamp. In suchembodiments, inflating the balloon may close the clamp and deflating theballoon may allow the clamp to open.

The clamp may include a first rotatable arm. The clamp may include asecond rotatable arm. The first and second rotatable arms may beconfigured to rotate about a pivot.

The first rotatable arm may be inserted into a sleeve. The sleeve maymaintain a position of the clamp relative to a junction of the tubingand the conduit. The sleeve may prevent the clamp from shifting out ofposition when the conduit shifts. The sleeve may prevent a twisting ofthe clamp about a longitudinal axis of the first lumen.

For example, the transport system may be implanted in a human body.Locomotion of the body may shift a position of the conduit with respectto the tubing. The sleeve may ensure that the clamp is positioned toseal the flexible portion of the tubing despite shifting of the conduit.

The sleeve may be a first sleeve. In some embodiments, a secondrotatable arm of the clamp may be inserted into a second sleeve. Thefirst sleeve may maintain a position of the first rotatable arm relativeto the junction. The second sleeve may maintain a position of the secondrotatable arm relative to the junction.

The sleeves may be formed at least in part, by a portion of the tubing.The sleeves may be formed from solid non-thrombogenic plastic or anysuitable materials. Exemplary suitable materials may include Dacron,Gore-Tex, polytetrafluoroethylene (“PTFE”), fluoropolymer products andany material suitable for implantation in a human body.

Apparatus may include, and methods may involve, a graft. The graft maybe attached to a conduit. The conduit may be an artery or a vein or acarrier or any suitable medium. The graft may include tubing configuredto be anastomized to the conduit. The tubing may include a compressibleportion. The tubing may include a non-compressible portion. Thecompressible portion may be located between the conduit and thenon-compressible portion of the tubing.

The graft may include a clamp. The clamp may be rotatable about a pivot.The pivot may be fused to the tubing. The clamp may be biased to crimpthe compressible portion of the tubing. The clamp may be positioned tocrimp the compressible portion of the tubing flush with an inner lumenof the blood vessel.

The graft may include a sleeve that positions the clamp to crimp thecompressible portion of the tubing flush with an inner lumen of theblood vessel. The graft may include a sleeve. The sleeve may includethree walls. The sleeve may be open on a fourth side to receive an armof the clamp. The three sides of the sleeve may be formed from an outerwall of the tubing, material extending substantially parallel to theouter wall of the tubing and material extending substantiallyperpendicular to the outer wall of the tubing. When an angularanastomosis is deployed, the third wall may be formed from material thatis substantially parallel to a longitudinal axis of the conduit.

In some embodiments the clamp may include two or more rotatable arms. Insome embodiments, the graft may include two or more sleeves to hold twoor more arms of the clamp.

For example, the graft may include a second sleeve constructed from theouter wall of the tubing, second material extending substantiallyparallel to the outer wall and second material extending substantiallyperpendicular to the outer wall of the tubing.

Closing the clamp on the compressible portion of the tubing may crimpthe tubing. Crimping the tubing may result in a collapse of a lumen ofthe tubing. Collapsing the lumen of the tubing may prevent fluid fromexiting or entering the tubing.

The graft may include a balloon. The balloon may be positioned insidethe clamp. The balloon may be positioned about the non-compressibleportion of the tubing.

The balloon, when inflated about the non-compressible portion of thetubing, may rotate the clamp about the pivot, opening the clamp andreleasing the clamp from the compressible portion of the tubing. Uponbeing released from the clamp, the compressible tubing may return to anexpanded state forming a lumen within the tubing. After expanding, thelumen may receive or transmit fluid.

The graft may include an elastic band that biases the clamp to crimp thecompressible portion of the tubing. The elastic band may encircle firstand second rotatable arms of the clamp. The elastic band may be anO-ring. The clamp may be biased using any suitable biasing member. Forexample, the clamp may be biased with a clip having a “memory” for acertain shape. The clip may be constructed from plastic or metal anysuitable material. For example, the clip may be constructed fromNitinol, a memory shape alloy.

The tubing may be a first tubing. The graft may include a second tubing.The second tubing may include inflatable material encircling the firsttubing. The inflatable material may be the balloon. In some embodiments,the inflatable material may be crimped to seal fluid within the secondtubing. In some embodiments, a plug may encircle the first tubing andseal fluid within the second tubing.

Sealing the fluid within the second tubing may force the balloon toinflate in response to pressurizing the second tubing. The second tubingmay be pressurized by the moveable platform compressing a bladder in thereservoir. Compressing the bladder may expel fluid from the bladder intothe second tubing.

The plug may include a flange. The flange may be circular. The flangemay be configured to mate with a corresponding indent in the clamp. Themating of the flange and the indent may fix a position of the clamprelative to the blood vessel. The mating of the flange and the indentmay fix a position of the clamp along a longitudinal axis of the tubing.The mating of the flange and the indent may fix a position of clampabout the longitudinal axis of the tubing.

Methods may include accessing a blood vessel via a graft anastomized tothe blood vessel. The method may include inserting a needle through aseptum of a subcutaneous reservoir. The methods may include expanding afirst chamber of the subcutaneous reservoir by pressing the needleagainst a moveable platform. The moveable platform may fluidly seal thefirst chamber from a second chamber of the reservoir.

The methods may include generating hydraulic pressure by compressing themoveable platform against a liquid-filled bladder housed within thesecond chamber. Using the hydraulic pressure, the methods may includeopening a clamp. The clamp may be biased to compress a resilient segmentof tubing anastomized to the blood vessel. Compressing the resilientsegment of the tubing may collapse a lumen of the tubing. When the clampis opened, the resilient segment of the tubing may expand, reopening thecollapsed lumen.

The methods may include directing blood, via the resilient segment oftubing, from the blood vessel to the first chamber of the reservoir.Methods may include extracting the blood from the first chamber. Theblood may be extracted using the needle inserted through the septum intothe first chamber.

The graft may be a first graft. The subcutaneous reservoir may be afirst subcutaneous reservoir. The methods may include transferring bloodextracted from the first subcutaneous reservoir to a dialysis machineand filtering the blood. The filtered blood may then be transferred to asecond subcutaneous reservoir. The methods may include reintroducing thefiltered blood to circulation via a second graft.

The first graft may be anastomized to an artery. The first graft may beanastomized to a vein. The second graft may be anastomized to a vein.The second graft may be anastomized to an artery. In some embodiments, aplurality of grafts may be implanted. Each of the plurality of graftsmay be anastomized to one or more blood vessels.

Methods may include locking the moveable platform at a distance from theseptum. The locking the moveable platform may maintain a threshold levelof hydraulic pressure. The threshold level of hydraulic pressure maykeep the balloon inflated and the clamp open.

Pressure may be applied to the needle to press the needle against themoveable platform to unlock the moveable platform. Unlocking themoveable platform may allow a biasing member inside the reservoir tocollapse the first chamber of the subcutaneous reservoir. Collapsing thefirst chamber may allow the bladder to inflate, thereby reducing thehydraulic pressure transmitted to the balloon. The loss of hydraulicpressure may deflate the balloon allowing the biasing member of theclamp to close the clamp upon the resilient segment of tubing and sealthe blood vessel from the graft.

The method may include positioning the clamp so that outer walls of theresilient tubing are sealed flush with each other. Sealing the resilienttubing in this manner may allow the blood vessel to maintain a uniformor substantially uniform blood flow through the blood vessel across theanastomization site after the closing of the clamp. The uniform bloodflow may correspond to a native blood flow through the vessel.

Apparatus and methods described herein are illustrative. Apparatus andmethods of the invention may involve some or all of the features of theillustrative apparatus and/or some or all of the steps of theillustrative methods. The steps of the methods may be performed in anorder other than the order shown and described herein. Some embodimentsmay omit steps shown and described in connection with the illustrativemethods. Some embodiments may include steps that are not shown anddescribed in connection with the illustrative methods.

Illustrative embodiments of apparatus and methods in accordance with theprinciples of the invention will now be described with reference to theaccompanying drawings, which form a part hereof. The drawings showillustrative features of apparatus and methods in accordance with theprinciples of the invention. The features are illustrated in the contextof selected embodiments. It will be understood that features shown inconnection with one of the embodiments may be practiced in accordancewith the principles of the invention along with features shown inconnection with another of the embodiments.

The apparatus and methods of the invention will be described inconnection with exemplary embodiments. It is to be understood that otherembodiments may be utilized and structural, functional and proceduralmodifications may be made without departing from the scope and spirit ofthe present invention.

FIG. 1 shows illustrative therapeutic scenario 100.

Scenario 100 shows limb 105. Limb 105 includes vein 103 and artery 101.Scenario 100 shows access port 107. Port 107 is affixed to artery 101.Port 107 may be affixed to any suitable blood vessel, such as vein 103.Port 107 may be affixed to artery 101 using a surgical technique. Thesurgical technique may include anastomosis and arteriotomy/venotomy. Theanastomosis may be an end-to-end straight anastomosis. The anastomosismay include an end-to-end angled anastomosis. The anastomosis mayinclude a side to end or side to side anastomosis. The angledanastomosis may be “bulbous.” An angled anastomosis may maintain laminarflow and reduce turbulence of blood flowing through blood vessel 101 or103. Any suitable techniques may be used to affix port 107 to a bloodvessel 103 or 101.

Port 107 is coupled via tubing 111 to reservoir 109. Tubing 111 mayallow access to “deep” blood vessels. Reservoir 109 may be affixed tolimb 105 subcutaneously. Reservoir 109 may be configured to receive oneof feeds 113. Feeds 113 draw blood from a blood vessel. Feeds 113 mayterminate in a needle or any other suitable connection to reservoir 109.For example, the feeds may terminate in a 14-16 gauge needle. Feeds 113transfer blood to dialysis machine 115. Feeds 113 transfer bloodextracted from blood vessel 101 to dialysis machine 115. Dialysismachine 115 may filter the blood extracted from blood vessel 101.Dialysis machine 115 may return filtered blood to blood vessel 103 viafeeds 113.

In some embodiments, a system including reservoir 109, tubing 111 andport 107 may be affixed to vein 103. Reservoir 109 may receive filteredblood from dialysis machine 115 via feeds 113. The filtered blood may bepumped through reservoir 109, through tubing 111 and returned tocirculation in blood vessel 103 through port 107.

One or more components of reservoir 109 may seal tubing 111 and port107. Sealing tubing 111 and port 107 may not allow blood to flow fromblood vessel 101 into port 107 or tubing 111. Reservoir 109 may beconfigured to sequentially seal tubing 111 prior to or after sealingport 107.

FIG. 2 shows illustrative apparatus 200. Apparatus 200 may include port202. Port 202 may include one or more of the features of port 107 (shownin FIG. 1). Port 202 may be in fluid connection with tubing 204. Tubing204 may include one or more features of tubing 111 (shown in FIG. 1).Tubing 204 may be in fluid connection with reservoir 206. Reservoir 206may include one or more reservoirs such as reservoir 223 and reservoir231. Reservoir 206 may include one or more features of reservoir 109(shown in FIG. 1).

Port 202 may include housing 201. Housing 201 may be constructed fromsolid non-thrombogenic plastic or any suitable materials. Exemplarysuitable materials may include Dacron, Gore-Tex, polytetrafluoroethylene(“PTFE”), fluoropolymer products and any material suitable forimplantation in a human body. Suitable material may include materialapproved by a government agency, such as the United States Food and DrugAdministration, for use in a human body.

Port 202 may include swing-arm 203. Swing-arm 203 may be constructedfrom and/or coated with Dacron, Gore-Tex, PTFE, fluoropolymer productsor any suitable material. Swing-arm 203 may rotate about hinge 233.Hinge 233 may be constructed from a pliable Dacron, Gore-Tex, PTFE,fluoropolymer products or any suitable material. Swing-arm 203 may beconfigured to rotate about hinge 233 and allow blood to flow betweenblood vessel 243 and housing 201. Blood may flow from blood vessel 243into housing 201. Blood may flow from housing 201 into blood vessel 243.Swing-arm 203 may be configured to rotate about hinge 233 and impedeand/or cut-off blood flow between blood vessel 243 and housing 201.

Swing-arm 203 may be configured to rotate about hinge 233 in response inan increase in pressure inside chamber 205. Chamber 205 may be anysuitable shape. Chamber 205 may be circular, square or triangular.Chamber 205 may be in fluid connection with lumen 209. Lumen 209 may bein fluid connection with chamber 229.

Needle 227 may inject a medium into chamber 229. The medium maypreferable be a liquid, such as a saline solution. The medium mayinclude any suitable liquid or gas. Adapter 236 prevents a leakage ofmedium flowing between lumen 209 and chamber 229. Adapter 241 prevents aleakage of the medium flowing between lumen 209 and chamber 205.Adapters 236 or 241 may be any suitable adapter. For example, an adaptermay hermetically seal lumen 209 and chamber 229. The adapter may includea threaded screw.

Injecting the medium into chamber 229 may force the medium through lumen209 and into chamber 205. Forcing the medium into chamber 205 mayincrease a pressure inside chamber 205. The increased pressure insidechamber 205 may cause swing-arm 203 to rotate about hinge 233. Rotationof swing-arm 203 about hinge 233 may “push” swing-arm 203 toward bloodvessel 243. Pressure in chamber 205 and rotation of swing-arm 203 abouthinge 233 may result in swing-arm 203 sealing housing 201 from bloodflowing through blood vessel 243.

Needle 227 may inject the medium until a threshold pressure inside lumen205 is obtained. Needle 227 may include a pressure gauge (not shown).The threshold pressure may correspond to a degree of rotation ofswing-arm 203 about hinge 233. The threshold pressure may correspond toa positioning of swing-arm 203 about hinge 233 such that swing-arm 203is substantially parallel to blood vessel 243. The threshold pressuremay correspond to a positioning of swing-arm 203 about hinge 233 suchthat blood does not flow into housing 201.

Reservoir 231 includes membrane 225. Membrane 225 may be a self-sealingmembrane. Needle 227 may inject the medium into reservoir 231 bypenetrating self-sealing membrane 225. After a registering of athreshold pressure, needle 227 may be withdrawn through self-sealingmembrane 225. Self-sealing membrane may prevent any medium leakage afterwithdrawal of needle 227. Self-sealing membrane 225 may maintain thethreshold pressure until a portion of the medium is extracted fromchamber 229.

Needle 227 may extract a portion of the medium from chamber 229.Extracting a portion of the medium may adjust the threshold pressure.Extracting a portion of the medium may adjust pressure on swing-arm 203.Extracting the portion of the medium may reduce the threshold pressureimposed on swing-arm 203. Extracting the portion of the medium mayimpose a negative pressure on swing-arm 203. The negative pressure mayresult in swing-arm 203 rotating about hinge 233. Rotation of swing-arm203 may contract chamber 205.

Extracting the portion of the medium may open housing 201 to bloodflowing within blood vessel 243. Extracting at least a portion of themedium from reservoir may result in swing-arm 203 rotating about hinge233. The rotation of swing-arm 203 about hinge 233 may unseal an orificebetween housing 201 and blood vessel 243. Rotation of swing-arm 203about hinge 233 may allow blood to flow from blood vessel 243 intohousing 201. The blood may flow from blood vessel 243 into passageway207. A pressure exerted on blood within blood vessel 243 may force theblood into lumen passageway 207. The pressure may be arterial bloodpressure. Blood within passageway 207 may flow into lumen 211. Adapter239 may join passageway 207 and lumen 211. Adapter 239 may preventleakage of blood flowing between passageway 207 and lumen 211.

Reservoir 223 includes chamber 213. Reservoir 223 includes membrane 215.Membrane 215 may be a self-sealing membrane. Chamber 213 may be expandedor contracted by movement of platform 219. Platform 219 may be rigid.Platform 219 may be biased relative to self-sealing membrane 215 bysprings 221. Platform 219 may be biased using any suitable pressureexerting member. A pressure exerting member may include elasticmembranes and springs. Platform 219 may be biased to contract chamber213. Platform 219 may be biased to exert pressure on self-sealingmembrane 215.

Needle 217 may penetrate self-sealing membrane 215. Needle 217 may be influid connection with feeds 113 (shown in FIG. 1). Needle 217 may pushplatform 219 away from self-sealing membrane 215. Movement of platform219 away from self-sealing membrane 215 may expand chamber 213.Expanding chamber 213 may allow blood to flow from lumen 211 intochamber 213. Lumen 211 may be joined to reservoir 223 by adapter 235.Adapter 235 may provide a leak-proof connection between chamber 213 andlumen 211. Adapter 235 may provide a hermetical connection betweenchamber 213 and lumen 211.

Needle 217 may extract blood from chamber 213. Blood extracted fromchamber 213 may be transferred to dialysis machine 115 (shown in FIG.1). Blood extracted from chamber 213 may be filtered by dialysis machine115.

Needle 217 may inject blood into chamber 213. Blood injected intochamber 213 may be reintroduced into circulation by travelling throughlumen 211, through passageway 207 and into blood vessel 243.

Chamber 213 may include internal walls 247 and 245. Walls 247 and 245may be flexible. Walls 247 and 245 may be constructed from Dacron,Gore-Tex, PTFE, fluoropolymer products or any other suitable material.Walls 247 and 245 may allow for expansion and/or contraction of chamber213. Walls 247 and 245 may prevent blood from leaking out of chamber213.

When needle 217 is removed from self-sealing membrane 215, springs 221may exert pressure on platform 219. The pressure may “push” platform 219toward membrane 215. Movement of platform 219 may purge blood or anyother medium present in chamber 213.

Following a purging of chamber 213, lumen 211 may be sealed. Lumen 211may be sealed by injecting a medium into chamber 229. Injection of themedium may increase pressure inside lumen 209. The increased pressuremay result in a diameter of lumen 209 expanding. Expansion of lumen 209may decrease a diameter of lumen 211. Expansion of lumen 209 may seallumen 211. Lumen 209 may be configured to expand faster proximal toreservoir 223 and more slowly proximal to housing 201. Bendingresistances of tubing 204 may vary longitudinally along lumen 209. Thedifferent expansion rates may “squeeze” any residual medium present inlumen 211 into passageway 207.

Apparatus 200 may be configured to allow for a full expansion of lumen209 and corresponding sealing of lumen 211 prior to a sealing ofpassageway 207. Sequential sealing may allow any residual medium presentin lumen 211 to be “squeezed” through lumen 211 and through passageway207 before sealing passageway 207. Continuous injection of medium intochamber 229 may seal lumen 211 and passageway 207. Completion of thesealing of lumen 211 and passageway 207 may correspond to a registeringof a threshold pressure inside chamber 229.

In some embodiments, tubing 204 may be fused to reservoir 206. Fusingtubing 204 and reservoir 206 may allow residual medium to be “squeezed”out of a juncture between tubing 204 and reservoir 206. Some embodimentsmay not include tubing 204. For example, reservoir 206 may be fuseddirectly to port 202.

Components of apparatus 200 may be sized (i.e., length, width, diameter,circumference, area) to achieve a blood flow that will allow completionof a dialysis procedure within a target time period.

FIG. 3A shows illustrative port 300. Port 300 may include one or morefeatures of port 107 (shown in FIG. 1) or port 202 (shown in FIG. 2).Port 300 may be joined to a blood vessel via patch 237. Patch 237 may beconstructed from Dacron, Gore-Tex, PTFE, fluoropolymer products or anyother suitable material. Patch 237 may include excess material. Theexcess material may be “trimmed” by a surgeon or other practitionerallowing for tailored positioning of patch 237. Patch 237 may be affixedto a blood vessel such as artery 101, vein 103 (shown in FIG. 1) orblood vessel 243 (shown in FIG. 2). Patch 237 may be affixed to a bloodvessel by anastomosis and arteriotomy or any other suitable technique.The anastomosis may include an end-to-end angled anastomosis. Theanastomosis may include a side to end or side to side anastomosis.

Port 300 may include housing 311. Port 300 may include chamber 307. Port300 may include passageway 317. Port 300 may include sealing member 309.Sealing member 309 may be rigid.

Port 300 may include flexible sealing portion 301. Flexible sealingportion 301 may be constructed from Dacron, Gore-Tex, PTFE,fluoropolymer products or any other suitable material. Flexible sealingportion 301 may be affixed to a first end of sealing member 309.

A second end of sealing member 309 may be affixed to hinge 319.Injecting a medium into chamber 307 may expand chamber 307. Chamber 307may expand by rotating sealing member 309 through variable angle ρ.Pressure within chamber 307 may position sealing member 309 by rotationthrough angle ρ. Pressure within chamber 307 may position sealing member309 substantially parallel to patch 237. Expansion of chamber 307 mayposition flexible sealing portion 301 substantially perpendicular tosealing member 309.

When sealing member 309 is positioned substantially parallel to patch237, blood may be prevented from flowing between patch 237 and orifice305. Positioning sealing member 309 substantially perpendicular tosealing portion 301 may obstruct passageway 317. Positioning sealingportion 301 substantially perpendicular to sealing member 309 mayprevent a flow through orifice 305. Sealing portion 301 may prevent aflow between passageway 317 and a tubing connection joined to adapter315. The tubing connection may include any suitable tubing such astubing 111 (shown in FIG. 1) or tubing 204 (shown in FIG. 2).

Orifice 305 may be directly coupled to a reservoir, such as reservoir206 (shown in FIG. 2). Adapter 315 may be directly coupled to areservoir, such as reservoir 206 (shown in FIG. 2). Channel 303 may bedirectly coupled to a reservoir such as a reservoir 206. One or morecomponents of port 300 or port 202 (shown in FIG. 2) may be directlycoupled to one or more components a reservoir such as reservoir 206(shown in FIG. 2) or reservoir 109 (shown in FIG. 1).

Injecting a medium into chamber 307 may position sealing member 309substantially parallel to patch 237. In a preferred embodiment, themedium may be a liquid. The medium may be a gas or any suitable medium.The medium may be injected into chamber 307 via channel 303.

FIG. 3B shows illustrative port 302. Port 302 may include one or morefeatures of port 300 (shown in FIG. 3A), port 202 (shown in FIG. 2) orport 107 (shown in FIG. 1). Port 302 may include orifice 321. Orifice321 may allow blood travelling in blood vessel 323 to enter port 302.Orifice 321 may allow blood in port 302 to flow into blood vessel 323.Blood vessel 323 may be an artery. Blood vessel 323 may be a vein. Bloodvessel 323 may be any suitable lumen of a circulatory system.

Orifice 321 may be sealed by swing-arm 203 (shown in FIG. 2) or sealingmember 309 (shown in FIG. 3A). Sealing of orifice 321 may prevent bloodor any other medium from flowing through orifice 321. Orifice 321 may besealed following completion of a dialysis procedure.

Port 302 includes orifice 305 (also shown in FIG. 3A). Orifice 305 mayallow blood to flow between a tubing and passageway 321. The tubing mayinclude any suitable tubing such as tubing 111 (shown in FIG. 1) ortubing 204 (shown in FIG. 2). Orifice 305 may be sealed by sealingportion 301 (shown in FIG. 3A). Sealing orifice 305 may prevent a flowof blood through orifice 305. Orifice 305 may be sealed followingcompletion of a dialysis procedure. Port 302 may be configured to sealorifice 305 prior to sealing orifice 321.

FIG. 4 shows illustrative port components 400. Port components 400 mayinclude one or more features of port 300 (shown in FIG. 3A), port 302(shown in FIG. 3B), port 202 (shown in FIG. 2) or port 107 (shown inFIG. 1). Port components 400 include housing 415. Housing 415 may beaffixed to a blood vessel via patch 237. Housing 415 includes orifices413 and 419. Blood may flow from orifice 419 to orifice 413. Blood mayflow from orifice 413 to orifice 419. Blood may flow through passageway414. Orifices 413 and 419 may be sized to allow for an optimal rate ofblood flow.

For example, orifice 413 may be larger in area than orifice 419. Orifice413 may be sized proportionally to patch 237. Orifices 413 and 419 maybe sized to complete a dialysis procedure within a target time period.

Port components 400 may include sealing member 421. Sealing member 421may include one or more features of swing-arm 203 (shown in FIG. 2) orsealing member 309 (shown in FIG. 3A). Sealing member 421 may beconfigured to seal orifice 413. Sealing orifice 413 may prevent a flowof blood through orifice 413. Sealing member 421 may be rigid.

Sealing member 421 may include one or more tenons 403. Tenons 403 may beseated in mortise 401. Tenons 403 may rotate in mortise 401. Tenons 403and mortise 401 may form a flexible joint. The flexible joint mayinclude one or more features of hinge 319 (shown in FIG. 3A) or hinge233 (shown in FIG. 2).

Port components 400 include balloon 405. Balloon 405 may be inflated.Balloon 405 may be inflated by injecting a medium through orifices 407.Balloon 405 may be deflated. Balloon 405 may be deflated by extractingthe medium via orifices 407. Balloon 405 may include one or morefeatures of chamber 307 (shown in FIG. 3A) or chamber 203 (shown in FIG.2).

Balloon 405 may be configured to expand and/or contract about angle θ.When balloon 405 is deflated, balloon 405 may be configured to foldalong creases 409. Balloon 405 may be affixed to sealing member 421.Expansion and/or contraction of balloon 405 may position sealing member421 relative to orifice 413.

Balloon 405, when inflated, may position sealing member 421 over orifice413. Balloon 405 may apply pressure to sealing member 421 to create aleak-proof seal over orifice 413. When positioned over orifice 421,sealing member 421 may prevent blood flow through passageway 414.Balloon 405 may be inflated to a pre-determined pressure. Thepre-determined pressure may correspond to a position of sealing member421 relative to orifice 413.

Balloon 405 may include panel 423. Balloon 405 may include panel 425.Balloon 405 may seal orifice 419. Inflating balloon 405 may seal orifice419. Balloon 405 may include one or more features of sealing portion 301(shown in FIG. 3A). The pre-determined pressure may correspond to aposition of panels 423 and 425 relative to orifice 419. Thepre-determined pressure may correspond to panels 423 and 425 beingpositioned substantially parallel to orifice 419.

Housing 415 may include orifices 417. Orifices 417 may be aligned withorifices 407 of balloon 405. Inflating balloon 405 may include injectinga medium though orifices 417, through orifices 407 and into balloon 405.Deflating balloon 405 may include extracting the medium from balloon 405via orifices 407 and 417.

In some embodiments, a top of panel 425 may be affixed to housing 415below orifices 417. Housing roof 411 may form a top of balloon 405.Medium flowing through orifices 417 may “spill” into balloon 405expanding balloon 405.

Port components 400 include housing roof 411. Balloon 405 may be affixedto housing roof 411. Housing roof 411 may remain stationary relative tomovement of sealing member 421. Housing roof 411 may remain stationaryrelative to inflation/deflation of balloon 405. Deflating balloon 405may generate a negative pressure inside balloon 405. The negativepressure may move sealing member 421 relative to housing roof 411.Negative pressure inside balloon 405 may move sealing member 421relative to orifice 413.

Housing roof 411 may include biasing members (not shown). The biasingmembers may include elastic membranes, springs or any suitable biasingmember. The biasing members may include one or more feature of biasingmembers 221 (shown in FIG. 2). The biasing members may be positionedbetween housing roof 411 and sealing member 421. The biasing members maypenetrate balloon 405. The biasing members may be encapsulated withinballoon 405. The biasing members may bias sealing member 421 relative tohousing roof 411.

The bias may correspond to attraction between sealing member 421 andhousing roof 411. The bias may correspond to repulsion between sealingmember 421 and housing roof 411. The biasing members may pull sealingmember 421 away from orifice 413 during a deflation of balloon 405. Thebiasing members may pull sealing member 421 toward orifice 413 duringinflation of balloon 405.

FIG. 5A shows illustrative tubing 500. Tubing 500 may include one ormore features of tubing 204 (shown in FIG. 2) or tubing 111 (shown inFIG. 1). Tubing 500 may be affixed to a blood vessel via an angledbulbous anastomosis and arteriotomy. Via the angled bulbous anastomosisand arteriotomy, tubing 500 may be affixed a blood vessel such as anartery or vein without a port such as port 300 (shown in FIG. 3A), port202 (shown in FIG. 2) or port 107 (shown in FIG. 1). In a preferredembodiment, tubing 500 is coupled to a port such as port 300 (shown inFIG. 3A), port 202 (shown in FIG. 2) or port 107 (shown in FIG. 1)

Tubing 500 includes sheath 502. Tubing 500 includes baffle 505. Tubing500 includes lumen 501. Tubing 500 includes lumen 503. Baffle 505 mayseparate lumen 501 and lumen 503. Lumen 503 may transport a medium forinflating/deflating balloon 405 (shown in FIG. 4). Lumen 503 may carry amedium for increasing pressure in chamber 205 (shown in FIG. 2) orchamber 307 (shown in FIG. 3A). Lumen 503 may transport blood between ablood vessel and reservoir 213 (shown in FIG. 2). Lumen 501 may includeone or more features of lumen 503.

In a preferred embodiment, a blood transporting lumen of tubing 500 isoriented superiorly with respect to an outer body surface orintegumentary tissue. A superiorly oriented lumen may allow access tothe blood carrying lumen. Access may be needed to clear a thrombosis orother obstruction in the blood carrying lumen.

Baffle 505 may be configured to stretch. Baffle 505 may be configured tobend. Baffle 505 may be configured to obstruct lumen 501 and/or lumen503. Baffle 505 may impermeably obstruct lumen 501 or lumen 503. Forexample, a medium may be injected into lumen 501 via needle 227 (shownin FIG. 2). The medium may enter lumen 501 and fill chamber 307 (shownin FIG. 3A). The filling of chamber 307 may increase pressure on atleast a portion of sheath 502 and baffle 505. Baffle 505 may be elastic.Sheath 502 may be inelastic relative to baffle 505. In response to theincreased pressure, baffle 505 may bulge into lumen 503. Baffle 505 maybulge and obstruct a flow through lumen 503. Pressure inside lumen 501may be increased until baffle 505 bulges and impermeably seals lumen503.

Baffle 505 may bend at different rates along a length of sheath 502.Different bending properties along the length of sheath 502 may resultin baffle 505 “pushing” blood or other medium in lumen 503 along thelength of sheath 502. For example, a first length of baffle 505 alongaxis Y may be configured to bulge when subject to a pressure of P₁. Asecond length of baffle 505 along axis Y may be configured to bulge whenthe pressure corresponds to P₂. P₁ and P₂ may be any suitable values ofpressure. In a preferred embodiment P₂ is greater than P₁. Baffle 505may be associated with any suitable pressure gradient along axis Y.

FIG. 5B shows a sectional view of an illustrative expansion of lumen 503and corresponding sealing of lumen 501. At point A, a diameter of lumen501 may be at a maximum. At point A, a diameter of lumen 503 may be at aminimum. When the diameter of lumen 501 is at a maximum, lumen 501 maybe configured to transport a target flow. The target flow may correspondto a flow of blood from a blood vessel to dialysis machine 115 (shown inFIG. 1).

At point B, a medium may be injected into lumen 503. Injection of themedium may increase pressure inside lumen 503. The increased pressureinside lumen 503 may result in baffle 505 bulging into lumen 501. Thebulging of baffle 505 into lumen 501 may obstruct a flow through lumen501. Baffle 505 may be configured to adjust a flow rate through lumen501.

At point C, continuous injection of the medium into lumen 503 has“stretched” baffle 505 across lumen 501 and against sheath 502. Thepressure of baffle 505 pressing against sheath 502 may impede a flowthrough lumen 501. The pressure of baffle 505 pressing against sheath502 may create an impermeable seal that prevents a flow through lumen501.

FIG. 5C shows illustrative tubing 504. Tubing 504 may include one ormore features of tubing 111 (shown in FIG. 1), tubing 204 (shown in FIG.2) or tubing 500 (shown in FIG. 5A). Tubing 504 may terminate in anangled bulbous anastomosis and arteriotomy. Via the angled bulbousanastomosis and arteriotomy, tubing 500 may be directly affixed a bloodvessel such as an artery or vein.

Tubing 504 includes sheath 510. Tubing 504 includes lumen 507. Lumen 507may be open at a first end of tubing 504. Lumen 507 may be closed at asecond end of tubing 504. Tubing 504 includes lumen 514. Tubing includesinner lining 511. Tubing 504 includes plug 509. Plug 509 may berotatably connected to inner lining 511. Plug 509 may be connected toinner lining 51 using Dacron, Gore-Tex, PTFE, fluoropolymer products orany suitable material. Inner lining 511 and plug 509 may rotate, withrespect to each other, about angle α.

At point A, angle α may be approximately 180°. At point A, a diameter oflumen 514 may be at a maximum. When the diameter of lumen 514 is at amaximum, lumen 514 may be configured to transport a target flow. Thetarget flow may correspond to a flow of blood from or to a blood vessel.

At point B, a medium may be injected into lumen 507. Injection of themedium into lumen 507 may cause adjustment of angle α between innerlining 511 and plug 509. Injection of the medium into lumen 507 maydecrease angle α. A decrease in angle α may correspond to an increase ina diameter of lumen 507. A decrease in angle α may correspond to adecrease in a diameter of lumen 514. A decrease in the diameter of lumen514 may obstruct a flow through lumen 514.

At point C, angle α may be approximately 90°. At point C, plug 509 mayblock any flow into or through lumen 514. At point C, lumen 507 may befull of the injected medium. The injected medium may generate pressureinside lumen 507. The pressure may maintain a position of plug 509 withrespect to lumen 514. The pressure may maintain a value of angle α. Thepressure may maintain a value of angle α at approximately 90°.

The medium may be injected into lumen 514 using needle 227 (shown inFIG. 2). Self-sealing membrane 225 (shown in FIG. 2) may maintain theinjected medium and corresponding pressure inside lumen 507.

FIG. 5D shows illustrative views A-C of tubing 504. Each of views A-Ccorresponds to a change in angle α and corresponding position of plug509 within lumen 514.

At point A, angle α is approximately 180°. At point A, a diameter oflumen 514 is at a maximum. At point B, angle α has been decreased. Thedecrease in angle α corresponds to a decrease in the diameter of lumen514. The decrease in angle α corresponds to an increase in a diameter oflumen 507. Injecting a medium into lumen 507 may result in plug 509extending into lumen 514. Injecting a medium into lumen 507 may resultin plug 509 obstruction at least a portion of lumen 514. Rotation ofplug 509 relative to inner lining 511 may correspond to a decrease inangle α.

At point C, plug 509 is positioned to prevent blood or any other fluidfrom entering lumen 514. At point C, a diameter of lumen 507 is at amaximum. Extracting the medium from lumen 507 may increase angle α, andallow a flow to enter lumen 514.

FIG. 5E shows illustrative views 506A and 506B of a portion of tubing500 taken along lines 1-1 (shown in FIG. 5A). Tubing 500 (shown in FIG.5A), tubing 204 (shown in FIG. 2) or tubing 111 (shown in FIG. 1) mayinclude one or more features of illustrative view 506.

Illustrative view 506A shows sheath 508. Illustrative view 506A showsbaffle 515. Illustrative view 506A shows lumen 513 and lumen 517. Atleast a portion of lumen 517 may be lined with a flexible material suchas Dacron, Gore-Tex, PTFE, fluoropolymer products or any suitablematerial. Baffle 515 may be the portion of lumen 517 lined with theflexible material. When lumen 513 is filled with a medium, baffle 515may expand or “bulge” into lumen 517. Expansion of baffle 515 into lumen517 may decrease a diameter of lumen 517 and obstruct a flow throughlumen 517. Baffle 515 may expand through lumen 517 and press against arigid portion of sheath 508. The pressure of baffle 515 against sheath508 may impermeably seal lumen 517.

In some embodiments, blood may travel through lumen 517. Lumen 517 maybe oriented superiorly with respect to an outer body surface orintegumentary tissue. A superiorly oriented lumen may allow access tothe blood carrying lumen. Access may be needed to clear a thrombosis orother obstruction in the blood carrying lumen.

In some embodiments, lumen 517 may be filled with a medium. Baffle 515may expand or “bulge” into lumen 513. Expansion of baffle 515 into lumen513 may decrease a diameter of lumen 513 and obstruct a flow throughlumen 513. Baffle 515 may expand through lumen 513 and press against arigid portion of sheath 508. The pressure of baffle 515 against sheath508 may impermeably seal lumen 513.

Illustrative views 506A and 506B show that sheath 508, lumen 517 andlumen 513 may include flexible material, rigid material or a combinationof both rigid and flexible material. Rigid material may includeplastics. The flexible material may include Dacron, Gore-Tex, PTFE,fluoropolymer products and any material suitable for implantation in ahuman body.

FIG. 5F shows illustrative views 572A and 572B. Illustrative view 572Ais taken along lines 2-2 (shown in FIG. 5C). Illustrative view 572B istaken along lines 3-3 (shown in FIG. 5C).

Illustrative view 572A shows sheath 519. Illustrative view 572A showsridge 521. Ridge 521 may be configured to provide a “catch” for a plug,such as plug 509 (shown in FIG. 5C). When angle α (shown in FIG. 5C) isapproximately 90°, plug 509 may be pressed against ridge 521. Pressingplug 509 against ridge 521 may create a seal that prevents a flow fromentering lumen 523. The flow may correspond to blood circulating in ablood vessel.

Illustrative view 572B shows an exemplary circular shape of ridge 521.Illustrative view 572B shows that ridge 521 may form a lining betweensheath 519 and lumen 523. A plug such as plug 509 (shown in FIG. 5C) maybe configured to close lumen 523 by pressing on ridge 521. Plug 509 mayhave a circular shape. Plug 509 may have a diameter that is larger thanthe diameter of ridge 521 and smaller than a diameter of sheath 519.Plug 509 may be square shaped, triangle shaped or have any suitableshape.

FIG. 5G shows illustrative tubing arrangements and therapeutictechniques 516, 518, 520, 522, 524A, 524B, 526, 528A and 528B.

Tubing arrangement 516 shows an illustrative anastomosis andarteriotomy. Tubing arrangement 516 shows lumen 537 and lumen 535.Arrangement 516 shows lumen 535 in a collapsed state and lumen 537 in anopen state. Lumens 535 and 537 may be affixed to patch 531. During ananastomosis and arteriotomy/venotomy patch 531 may be sutured intosurgical incision 533 in blood vessel 532. Expansion of lumen 535 mayseal lumen 537, and prevent blood from flowing out of blood vessel 532into lumen 537. Contraction of lumen 535 may allow blood to flow out ofblood vessel 532 into lumen 537. Blood entering lumen 537 from bloodvessel 532 may be transferred via lumen 537 to dialysis machine 115(shown in FIG. 1). Blood filtered by dialysis machine 115 may betransferred to blood vessel 532 via lumen 537.

Arrangement 518 shows an illustrative end-to-end “angled” anastomosis.Arrangement 518 shows lumen 541 and lumen 543. Lumens 541 and 543 may beaffixed to graft 539. Graft 539 may be sutured to blood vessel 532.Graft 539 may be sutured to blood vessel 532 at “angled” seam 538. Lumen543 may include one or more feature of lumen 537. Lumen 541 may includeone or more features of lumen 535.

Arrangement 520 shows an illustrative end-to-end “straight” anastomosis.Arrangement 520 shows lumen 547 and lumen 549. Lumens 547 and 549 may beaffixed to graft 545. Graft 539 may be sutured to blood vessel 532.Graft 545 may be sutured to blood vessel 532 at “straight” seam 546.Lumen 547 may include one or more features of lumen 535. Lumen 549 mayinclude one or more feature of lumen 537.

Arrangement 522 shows an illustrative angled “bulbous” anastomosis andarteriotomy. Arrangement 522 shows lumen 553 and lumen 555. Lumens 553and 555 may be affixed to patch 551. Patch 551 may be sutured to a bloodvessel such as blood vessel 532. Lumen 553 may include one or morefeatures of lumen 535. Lumen 555 may include one or more features oflumen 537.

Arrangement 524A shows an illustrative therapeutic scenario. Arrangement524A shows that tubing 559 may be angled with respect to patch 557.Tubing 559 may include one or more or more lumens, such as lumen 535and/or lumen 537. When tubing 563 is angled with respect to patch 561,angle ω may be greater than 90°. Tubing 559 may include one or morefeatures of tubing 111 (shown in FIG. 1), tubing 204 (shown in FIG. 2)tubing 500 (shown in FIG. 5A) or tubing 504 (shown in FIG. 5C).

Arrangement 524B shows another illustrative therapeutic scenario.Arrangement 524B shows that tubing 563 may be substantiallyperpendicular with respect to patch 561. When tubing 563 issubstantially perpendicular to patch 561, angle ω may be approximately90°. Tubing 563 may include one or more or more lumens, such as lumen535 and/or lumen 537. Tubing 559 may include one or more features oftubing 111 (shown in FIG. 1), tubing 204 (shown in FIG. 2) tubing 500(shown in FIG. 5A) and tubing 504 (shown in FIG. 5C).

An angle ω greater than 90° may maintain laminar blood flow within bloodvessel 532. An angle ω greater than 90° may reduce turbulent blood flowwithin blood vessel 532.

Arrangement 526 shows an illustrative therapeutic scenario. Arrangement526 shows tubing 573. Tubing 573 may include one or more features oftubing 500 (shown in FIG. 5A), tubing 504 (shown in FIG. 5C), tubing 204(shown in FIG. 2) or tubing 111 (shown in FIG. 1).

Tubing 573 includes lumen 571, lumen 575, plug 569 and ridge 565. Anexpansion of lumen 575 may rotate plug 569 about angle λ. Rotation ofplug 569 about angle λ may press plug 569 against ridge 565. Pressingplug 569 against ridge 565 may prevent blood from flowing through lumen571.

Lumen 575 may be expanded by injecting a medium into lumen 575. Themedium may be maintained inside lumen 575 by a reservoir. The reservoirmay be any suitable reservoir such as reservoir 231 (shown in FIG. 2) orreservoir 109 (shown in FIG. 1). A pressure of plug 569 against ridge565 may be maintained by a reservoir, such as reservoir 231.

Arrangement 528A shows an illustrative therapeutic scenario. Arrangement528A shows tubing 577 affixed to “flat” patch 581. Flat patch 581 may besutured to a blood vessel such as blood vessels 103 or 101 (shown inFIG. 1). After attachment to the blood vessel, tubing 577 may act asconduit to transfer blood to/from the blood vessel. Tubing 577 mayinclude a plug such as plug 569 or a baffle such as baffle 515 (shown inFIG. 5E). The plug or baffle may be configured to seal tubing 577 andprevent a flow through tubing 577.

Arrangement 528B shows another illustrative therapeutic scenario.Arrangement 528B shows tubing 579 affixed to “curved” patch 583. Curvedpatch 583 may be sutured to a blood vessel such as blood vessels 103 or101 (shown in FIG. 1). After attachment to the blood vessel, tubing 577may act as conduit to transfer blood to/from the blood vessel. Tubing579 may include a plug such as plug 569 or a baffle such as baffle 515(shown in FIG. 5E). The plug or baffle may be configured to seal tubing577 and prevent a flow through tubing 579.

FIG. 6A shows illustrative apparatus 600. Apparatus 600 includesreservoir 601. Reservoir 601 may include one or more features ofreservoir 223, reservoir 231 (both shown in FIG. 2) or reservoir 109(shown in FIG. 1).

Reservoir 601 includes chamber 613. Reservoir 601 includes self-sealingmembrane 615. Translation of platform 611 may expand or contract chamber613. Platform 611 may be biased within reservoir 601 by springs 619.Platform 611 may be biased relative to self-sealing membrane 615 bysprings 619. Platform 611 may be biased using any suitable pressureexerting member. Platform 611 may be biased to exert pressure onself-sealing membrane 615.

Needle 617 may penetrate self-sealing membrane 615. Needle 617 may be influid connection with feeds 113 (shown in FIG. 1). Inserting needle 617into chamber 613 may separate platform 611 from self-sealing membrane615. Pressure applied to needle 617 may condense springs 619 andtranslate platform 611. Translation of platform 611 away fromself-sealing membrane 615 may expand chamber 613. Expanding chamber 613may allow blood to flow from lumen 603 or 605 into chamber 613. Adapter635 may provide a leak-proof seal between chamber 613 and lumen 603 orlumen 605.

Needle 617 may extract blood from chamber 613. Blood extracted fromchamber 613 may be transferred to dialysis machine 115 (shown in FIG.1). Blood extracted from chamber 613 may be filtered by dialysis machine115. Blood filtered by dialysis machine 115 may be reintroduced intocirculation by injecting the filtered blood into chamber 613.

Chamber 613 may include walls 604. Walls 604 may be flexible. Walls 604may be constructed from Dacron, Gore-Tex, PTFE, fluoropolymer productsor any other suitable material. Walls 604 may allow for expansion and/orcontraction of chamber 613. Walls 604 may prevent blood from leaking outof chamber 613.

When needle 617 is removed from self-sealing membrane 615, springs 619may exert pressure on platform 615. Springs 619 may “push” platform 615toward self-sealing membrane 615. Movement of platform 615 towardself-sealing membrane may purge excess fluid from chamber 213. After atransfer of blood through chamber 613, chamber 613, tubing 607 andpassageway 207 (shown in FIG. 2) may be purged of residual blood bymovement of platform 611.

FIG. 6B shows illustrative scenario 602. In scenario 602, platform 611is pressed against self-sealing membrane 615. Biasing members 619 mayapply pressure to platform 611. The pressure applied by biasing members619 may cause platform 619 to translate. The pressure applied by biasingmembers 619 may cause platform 619 to translate and contract chamber613. The pressure applied by biasing members 619 may press platform 611against self-sealing membrane 615.

Translation of platform 611 and a corresponding contraction of chamber613 may expel medium present in chamber 613. The expulsion of mediumpresent in chamber 613 may force the medium through tubing 607 andthrough passageway 207. The expulsion of the medium from chamber 613 maycleanse tubing 607 and/or passageway 207.

For example, a first end to tubing 607 may be joined to adapter 635. Asecond end of tubing 607 may be joined to housing 201 via adapter 239(shown in FIG. 2). A saline solution may be introduced into chamber 613and tubing 607. The saline solution may flush out any blood present inchamber 613, tubing 607 or housing 201.

After introducing the saline solution, needle 617 may be removed fromchamber 613. Removal of needle 617 may allow platform 611 to translatetoward self-sealing membrane 615. Translation of platform 611 andcorresponding contraction of chamber 613 may “squeeze” the salinesolution out of chamber 613, through tubing 607 and through passageway207, thereby purging residual blood and/or saline present in chamber613, tubing 607 and/or passageway 207 (shown in FIG. 2). The salinesolution may be a heparinized solution designed to prevent bloodclotting within chamber 613, tubing 607 and/or passageway 207.

When platform 611 presses against self-sealing membrane 615, walls 604may fold into cutouts 608. When needle 617 pushes platform 611 away fromself-sealing member, walls 604 may un-fold and form sides of chamber613.

FIG. 7 shows illustrative apparatus 700, 702, 704A and 704B.

Apparatus 700 includes reservoir 701. Reservoir 701 may include one ormore features of reservoir 223, reservoir 231 (shown in FIG. 2) orreservoir 109 (shown in FIG. 1). Apparatus 700 includes tubing 737.Tubing 737 may include one or more features of tubing 500 (shown in FIG.5A), tubing 504 (shown in FIG. 5C), tubing 204 (shown in FIG. 2) ortubing 111 (shown in FIG. 1). A first end of tubing 737 may be joined toreservoir 701. A second end of tubing 737 may be joined to a port suchas port 400 (shown in FIG. 4), port 300 (shown in FIG. 3A), port 302(shown in FIG. 3B), port 202 (shown in FIG. 2) or port 107 (shown inFIG. 1).

Reservoir 701 includes self-sealing membranes 721 and 725. A needle maypenetrate self-sealing membrane 721 and inject a medium into chamber710. The injected medium may enter chamber 705 via channel 703 andorifice 713. Chamber 705 may be defined, at least in part, by floor 715.The injected medium may push platform 731 away from floor 715 and closerto self-sealing membrane 725.

Reservoir 701 may include a biasing members 712 between platform 731 andfloor 715. The biasing members may include a spring, elastic membrane orany other suitable biasing members. In response to reducing pressureapplied to platform 731, platform 731 may translate towards membrane725. A translation of platform 731 toward membrane 725 may collapselumen 723. A collapsed lumen 723 may be expanded by inserted a needle(not shown) through membrane 725. The needle may apply pressureovercoming a biasing force of biasing members 712. Biasing members 712may be insulated and/or sealed from a medium present in chamber 705.

Injecting the medium into chamber 710 may result in platform 731translating towards self-sealing membrane 725. The translation ofplatform 731 may force a cleansing agent present in chamber 723 intolumen 733 and through passageway 207 (shown in FIG. 2). The flow of thecleansing agent through passageway 207 may sanitize lumen 733 and/orpassageway 207.

Chamber 710 may be in fluid contact with lumen 735. The injected mediummay flow through chamber 710 into lumen 735. Adapter 729 may fluidlyjoin chamber 710 and lumen 735. Injection of the medium into chamber 710may expand lumen 205 and rotate swing-arm 203 about hinge 233 (shown inFIG. 2).

In response to the injection of medium into chamber 710, platform 731may be configured to translate and contract chamber 723. Chamber 723 maybe contracted prior to the fluid exerting sufficient pressure to expandlumen 735. In response to the injection of medium into chamber 703,lumen 735 may expand, thereby sealing lumen 733. Lumen may be sealedprior the injected fluid exerting sufficient pressure to expand lumen205 (shown in FIG. 2) and/or seal orifice 413 (shown in FIG. 4).

Apparatus 704 shows an illustrative component. Apparatus 704 included ina reservoir, such as reservoir 701, reservoir 223, reservoir 231 (shownin FIG. 2) or reservoir 109 (shown in FIG. 1). Apparatus 704 includesmembrane 739. Membrane 739 may be a self-sealing membrane. Apparatus 704may include platform 743. Platform 743 may be rigid.

Platform 743 may be configured to translate along axis X. A flow offluid into chamber 705 may cause platform 743 to translate towardsmembrane 739. Translation of platform 743 toward membrane 739 may foldwalls 707. Walls 707 may be biased to fold out of chamber 741.Translation of platform 743 toward membrane 739 may extend walls 709.Translation of platform 743 toward membrane 739 may expand chamber 705.

An extraction of fluid from chamber 705 may cause platform 743 totranslate toward floor 745. An extraction of fluid from chamber 705 maycreate a negative pressure. The negative pressure may pull platform 743toward floor 745.

Platform 743 may be biased along axis X. Platform 743 may be biased byone or more biasing members, such as biasing members 221 (shown in FIG.2).

Translation of platform 743 toward floor 745 may fold walls 709. Walls709 may be biased to fold out of chamber 705. Translation of platform743 toward floor 745 may extend walls 707. Translation of platform 743toward floor 745 may expand chamber 741.

Apparatus 704A shows an inferior view of reservoir 701. The inferiorview shows an outer housing 711 of channel 703. The inferior view showsa circular area swept out by walls 715. In broken line, the inferiorview shows a circular area swept out by orifice 713. The inferior viewshows an underside of chamber 710. Channel 703 may terminate at adapter729. The inferior view shows an underside of adapter 729. Channel 703may be joined to tubing 737 using adapter 729.

Apparatus 704B shows superior view of reservoir 701. The superior viewshows self-sealing membrane 725. Self-sealing membrane 725 may capchamber 723. The superior view shows self-sealing membrane 721.Self-sealing membrane 721 may cap chamber 710. The superior view alsoshows a top of adapter 727. Adapter 727 may join chamber 723 and tubing737.

FIG. 8 shows illustrative apparatus 800A, 800B, 800C and exemplarytherapeutic scenario 800D.

Apparatus 800A may be used to join blood vessel 802 and blood vessel804. Apparatus 800A may provide a system that allows blood to beextracted from one of blood vessels 802 or 804 and returned to one ofblood vessels 802 or 804. Blood extracted from blood vessel 802 or 804may be processed before being reintroduced into circulation. Theextracted blood may be dialysized before being returned to circulation.Apparatus 800A may provide a system that allows for blood to selectivelyflow between blood vessel 802 and blood vessel 804. Apparatus 800A mayprovide a system that prevents blood from continuously flowing betweenblood vessel 802 and blood vessel 804. For example, when blood is notbeing processed, blood may not flow through port 810, port 803, tubing805 or reservoir 806.

Apparatus 800A includes port 803. Port 803 may include one or morefeatures of port 202 (shown in FIG. 2), ports 300 and 302 (shown in FIG.3) and port 400 (shown in FIG. 4). Apparatus 800A includes port 810.Port 810 may include one or more features of port 202 (shown in FIG. 2),ports 300 and 302 (shown in FIG. 3) and port 400 (shown in FIG. 4).

Port 803 may be affixed to blood vessel 802. Port 803 may be affixed toblood vessel 804. Port 803 may be affixed to blood vessel 802 or 804using any suitable technique such as the techniques shown in FIG. 5G.

Port 803 may be joined to tubing 805. Tubing 805 may include one or morefeatures of tubing 111 (shown in FIG. 1), tubing 204 (shown in FIG. 2)and any tubings shown in FIGS. 5A-5G. In some embodiments (not shown),tubing 805 may be joined to blood vessel 802 or 804 without port 803.Tubing 805 may be joined to blood vessel 802 or 804 using any suitabletechnique such as the exemplary techniques shown in FIG. 5G.

Tubing 805 may join port 803 to reservoir 806. Tubing 805 may be joinedto port 803 using adapters 239 or 241 (shown in FIG. 2), adapters 315 or313 (shown in FIG. 3A), a “Christmas tree” type adapter, threaded screwor any suitable adapter. Tubing 805 may be fused to port 803.

Apparatus 800B and 800C show illustrative components of reservoir 806.Apparatus 800B includes chambers 808, 809 and 811. Chambers 809 and 811may each include one or more features of reservoir 601. For example,each of chambers 809 and 811 may be biased with respect to chamber 808by biasing members such as biasing members 619.

Chamber 808 may be stacked above chambers 809 and 811. In someembodiments (not shown), chambers 809 and 811 may be stacked abovechamber 808. Chamber 808 may be capped with membrane 807 (shown in800A). Membrane 807 may be a self-sealing membrane. Chambers 809 and 811may be separated by dividing wall 813. Dividing wall 813 may be animpermeable barrier. Apparatus 800C shows that chamber 808 may beseparated from chambers 809 and 811 by membrane 819. Membrane 819 may bea self-sealing membrane.

Tubing 805 may be coupled to chambers 808 and 811 via adapters 831 and835. Tubing 805 may be coupled to chambers 808 and 809 via adapters 825and 823.

Extracting a medium present in chamber 808 may unseal a swing-arm withinport 803 (shown in 800A) and/or port 810. Extracting a medium present inchamber 808 may unseal a lumen in tubing 805. Unsealing the lumen withintubing 805 and the swing-arm within port 803 may allow blood to flowbetween port 803 and chamber 811. Unsealing the lumen within tubing 805and the swing-arm within port 810 may allow blood to flow between port810 and chamber 809.

A needle (not shown) may penetrate membranes 807 and 819 and extractblood from chamber 811. By accessing chamber 811, blood may be extractedfrom blood vessel 804 (shown in 800A). Blood vessel 804 may be anartery. A needle (not shown) may penetrate membranes 807 and 819 andinject filtered blood into chamber 809. By accessing chamber 809, bloodmay be injected into blood vessel 802 (shown in 800A). Blood injectedinto chamber 809 may flow through tubing 805, though port 810 and intoblood vessel 802. Blood vessel 802 may be a vein. Blood vessel 802 maybe a vein.

Blood extracted from chamber 811 may be filtered by dialysis machine 115and returned to chamber 809. After a completion of a dialysis procedure,a medium, such as heparinized saline, may be injected into chamber 811and/or chamber 809. Injection of the medium may flush any residual bloodwithin chamber 811, chamber 809, tubing 805, port 810 and/or port 803.

A medium may be injected into chamber 808. Injecting the medium intochamber 808 may insulate tubing 805 and port 803 from blood flow inblood vessel 804. Tubing 805 may be constructing with varying degrees ofbending resistance so that a first portion of tubing 805 closer tochamber 811 is sealed prior to a second portion of tubing 805 closer toport 803. Tubing 805 may be sealed prior to sealing port 803.

In some embodiments, a cleansing solution, such as heparinized salinemay be injected into chamber 811. The heparinized saline may clear bloodpresent in chamber 811, tubing 805 and/or port 803. Following injectionof the heparinized saline, a medium may be injected into lumen 808sealing the transport system.

Injecting the medium into chamber 808 may seal tubing 805 and port 810from blood flow within blood vessel 802. Tubing 805 may be constructingwith varying degrees of bending resistance so that a first portion oftubing 805 closer to chamber 811 is sealed prior to a second portion oftubing 805 closer to port 810. Tubing 805 may be sealed prior to sealingport 810.

A needle inserted into reservoir 806 may include a pressure gauge (notshown). When the pressure gauge registers a threshold pressure, tubing805, port 803 and port 810 may all be sealed from blood flow in vessels804 and 802. Membrane 807 and membrane 819 may maintain the thresholdpressure within chamber 808 after needle 816 is withdrawn.

In some embodiments, reservoirs 808, 809 and 811 may be positionedadjacent to one another in a plane. For example, reservoirs 808, 809 and811 may form a “three leaf clover” shape. Each of reservoirs 808, 809and 811 may be a different shape. For example, reservoir 808 may have acircular shape. Reservoir 809 may have a square shape. Reservoir 811 mayhave a triangular shape. The different shapes may allow a practitioneraccessing the reservoirs to identify each reservoir by feeling orpalpitating each reservoir.

Scenario 800D shows an exemplary therapeutic scenario utilizing a“stacked” reservoir. The stacked reservoir may include one or morefeatures of reservoir 806 (shown in 800A). In scenario 800D, doublelumen needle 816 is inserted into chamber 837 by penetrating membranes829 and 833. Membrane 829 may include one or more features of membrane807 (shown in 800C). Membrane 833 may include one or more features ofmembrane 819 (shown in 800C). Lumen 817 may only penetrate membrane 829.Lumen 815 may penetrate both membrane 829 and 833. Lumen 817 may extracta medium from within chamber 839.

Extracting the medium from chamber 839 may unseal a swing-arm within aport such as port 803 and/or port 810 (shown in 800A). The swing-arm mayinclude one or more features of swing-arm 203 (shown in FIG. 2),swing-arm 309 (shown in FIG. 3) or swing-arm 421 (shown in FIG. 4). Forexample, port 803 may be coupled to chamber 839 via a tubing connectionsuch as tubing 805 (shown in 800A). Unsealing the swing-arm may allowblood to flow from blood vessel 804 (shown in 800A) into port 803. Theswing-arm may seal an orifice (not shown) between blood vessel 804 andhousing 803. The orifice may include one or more features of orifice 321(shown in FIG. 3) or orifice 413 (shown in FIG. 4).

Extracting the medium from chamber 839 may unseal a lumen (not shown)within the tubing coupled to chamber 839. For example, tubing 805 may becoupled to chamber 839, and a lumen within tubing 805 may include one ormore features of lumen 211 (shown in FIG. 2), lumen 501 (shown in FIG.5A) or lumen 514 (shown in FIG. 5C). Unsealing the lumen may allow bloodto flow into chamber 837. Blood flowing into chamber 837 may beextracted via lumen 815 of needle 816. Blood extracted via lumen 815 maybe transferred to dialysis machine 115 using feeds 113 (shown in FIG.1). Blood extracted via lumen 815 from chamber 837 may be filtered bydialysis machine 115 and returned to chamber 809 (shown in 800A) or areservoir such as reservoir 223 (shown in FIG. 2).

FIG. 9 shows illustrative process 900. Process 900 includes, at step901, opening a first system. The first system may include a first port.The first port may include one or more features of port 803 (shown inFIG. 8), port 300 (shown in FIG. 3A), port 202 (shown in FIG. 2) or port107 (shown in FIG. 1). The first system may include a first tubing. Thefirst tubing may one or more features of tubing 805 (shown in FIG. 8),tubing 500 (shown in FIG. 5A), tubing 504 (shown in FIG. 5C), tubing 204(shown in FIG. 2) or tubing 111 (shown in FIG. 1). The first system mayinclude a first subcutaneous reservoir. The first reservoir may includeone or more features of reservoir 806 (shown in FIG. 8), reservoir 231(shown in FIG. 2) or reservoir 109 (shown in FIG. 1).

Opening the first system may allow blood from a first blood vessel toflow through the first system. At step 903, blood flows through thefirst port, the first tubing and through the first subcutaneousreservoir. At step 905, blood flowing through the first system isdirected to a dialysis machine. The dialysis machine filters the blood.

At step 907, a second system is opened. The second system may includeone or more features of the first systems. For example the second systemmay include a second port, a second tubing, and a second subcutaneousreservoir. At step, 909, filtered blood is transferred from the dialysismachine to the second subcutaneous reservoir. At step 911, the filteredblood flows through the second subcutaneous reservoir, through thesecond tubing, and through the second port. The second port returns thefiltered blood circulation via a second blood vessel.

FIG. 10 shows illustrative process 1000. Process 1000 includes, at step1001, flushing a transport system. The transport system may include oneor more features of apparatus 800A (shown in FIG. 8) or apparatus 200(shown in FIG. 2). For example the transport system may include a firstreservoir such as reservoir 206 (shown in FIG. 2), a first lumen such aslumen 501 (shown in FIG. 5) and a port such as port 400 (shown in FIG.4). The first lumen may be coupled to the first reservoir. The flushingmay include, using a syringe, injecting a cleansing medium into a firstreservoir.

At step 1003, the cleansing medium travels through the first reservoir,the first lumen and the port. At step 1005, a needle is removed from thefirst reservoir. Removing the needle releases a pressure exerting memberin the first reservoir. For example, the pressure exerting member maycorrespond to spring 221 (shown in FIG. 2). At step 1007, the pressureexerting member exerts pressure on a chamber of the first reservoir andcollapses the chamber. For example, the chamber may correspond tochamber 213 (shown in FIG. 2), chamber 723 (shown in FIG. 7) or chamber809 (shown in FIG. 8). Collapsing the chamber pushes any excesscleansing medium out of the chamber into the first lumen.

At step 1009, a medium is injected into a second reservoir of thetransport system. The second reservoir may include one or more featuresof reservoir 231 (shown in FIG. 2), reservoir 701 (shown in FIG. 7) orreservoir 806 (shown in FIG. 8).

At step 1011, the medium travels through the second reservoir andthrough a second lumen. The second lumen may be coupled to the secondreservoir. As the medium travels through the second lumen, the secondlumen may expand progressively sealing the first lumen. For example, thesecond lumen may correspond to lumen 735 and the first lumen maycorrespond to lumen 733 (shown in FIG. 7).

Expansion of the second lumen may progressively seal the first lumenalong a length of the second lumen. The second lumen may be configuredto seal the first lumen beginning at a point the first lumen is coupledto the first reservoir and ending at a point the first lumen is coupledto the port. Progressively sealing of the first lumen pushes any excessmedium in first lumen into the port.

At step 1013, the medium injected into the second reservoir flows fromthe second lumen into a chamber of the port. The flow of medium into theport exerts pressure on a swing-arm of the port. The swing-arm mayinclude one or more features of swing-arm 203 (shown in FIG. 2), sealingmember 309 (shown in FIG. 3A) or sealing member 421 (shown in FIG. 4).

In response to the pressure exerted on the swing-arm, the swing-armrotates, positioning a plug over an aperture between the port and thefirst lumen. Rotation of the swing-arm pushes any excess medium out ofthe port into a blood vessel. At step 1017, in response continued flowof medium into the chamber and corresponding pressure exerted on theswing-arm, the swing-arm continues rotating, sealing an aperture betweenthe port and the blood vessel. The aperture may include one or morefeatures of orifice 419 (shown in FIG. 4) or orifice 305 (shown in FIG.3A) orifice.

At step 1019, a threshold pressure is monitored at the point ofinjection into the second reservoir. In response to detection of thethreshold pressure, the needle is withdrawn from the second reservoir.The threshold pressure may correspond to a completion of the sealingprocess. A self-sealing membrane may prevent a change in pressure afterwithdrawing the needle.

FIG. 11 shows illustrative apparatus 1100. Apparatus 1100 includestubing 1101. Apparatus 1100 includes clamp 1102. Clamp 1102 includesfirst rotatable arm 1103 and second rotatable arm 1105. First rotatablearm 1103 is affixed to tubing 1102 via hinge 1115. Second rotatable arm1105 is affixed to tubing 1101 via hinge 1113.

Hinges 1113 and 1115 may be aligned over pivot 1117. Pivot 1117 mayprotrude from tubing 1101. Hinges 1113 and 1115 may be configured torotate about pivot 1117. Clamp 1102 may be affixed to tubing 1101 aftertubing 1101 is anastomized to blood vessel 1109. Hinges 1113 and 1115may be fitted over a pivot 1117 after tubing 1101 is anastomized toblood vessel 1109. In some embodiments, clamp 1102 may be manufacturedas part of tubing 1101.

Clamp 1102 includes O-ring 1107. O-ring 1107 may bias rotatable arms1103 and 1105 to compress flexible tubing portion 1111. FIG. 11 showsclamp 1102 in a closed position. O-ring 1107 may maintain clamp 1102 inthe closed position. In the closed position, clamp 1102 compressesflexible portion 1111 of tubing 1101.

When clamp 1102 compresses flexible portion 1111, tubing 1101 isinsulated from blood or any other medium flowing through vessel 1109.When clamp 1102 compresses flexible portion 1111, fluid present intubing 1101 is insulated from vessel 1109. When clamp 1102 compressesflexible portion 1111 of tubing 1101, fluid flowing through vessel 1109may flow across an anastomization site unimpeded by any portion oftubing 1101.

FIG. 12 shows illustrative apparatus 1200. Apparatus 1200 includestubing 1201. Tubing 1201 may be anastomized to conduit 1213. Conduit1203 may be any fluid carrying medium such as an artery or vein.Apparatus 1200 includes clamp 1202. Clamp 1202 may include one or morefeatures of clamp 1102 (shown in FIG. 11).

Clamp 1202 includes rotatable arms 1203 and 1205. Hinges 1211 mayrotatably fix rotatable arm 1203 to tubing 1201. Hinges 1209 mayrotatably fix rotatable arm 1205 to tubing 1201. Rotatable hinges 1211and 1209 may rotate about pivot 1215. Some embodiments may not includehinges. For example, rotatable arms 1203 and 1205 may be clipped orotherwise affixed to tubing 1201. A bending resistance of rotatable arms1203 and 1205 may provide flexibility for clamp 1202 to expand andcontract.

Clamp 1202 includes O-ring positions 1207. Each of O-ring positions 1207may be configured to position an O-ring around clamp 1202. An O-ringposition may be selected based on a property of the conduit, tubing,anastomosis, clamp or any suitable requirement. In some embodiments, theclamp may include one pre-determined O-ring position.

FIG. 12 shows clamp 1202 in an open position. In the open position,rotatable arms 1203 and 1205 are separated by distance D. Opening clamp1202 may pivot rotatable arms 1203 and 1205 about pivot 1215. An amountof force needed to open clamp 1202 may depend on a seating of O-ring(s)within one or more of O-ring positions 1207.

Opening clamp 1202 a distance D may allow fluid flowing thorough conduit1213 to enter tubing 1201.

FIG. 13A shows illustrative apparatus 1300. Apparatus 1300 showsapparatus 1200 without rotatable arm 1205 exposing balloon 1307, end cap1309, shoulder 1310 and tubing section 1311.

Balloon 1307 may encircle tubing section 1311. Tubing section 1311 mayextend concentrically though tubing section 1201. Tubing section 1311may include a compressible segment. Tubing section 1311 may include anon-compressible segment. Balloon 1307 may completely or partiallyencircle the non-compressible segment of tubing 1310. Balloon 1307 maybe in fluid communication with fluid carried in tubing 1201. The fluidflowing through tubing 1201 may be used to inflate balloon 1307. End cap1309 may prevent the fluid from leaking out of balloon 1307 and tubing1201.

Inflating balloon 1307 may rotate rotatable arm 1203 and 1205 (shown inFIG. 12) opening clamp 1202 (shown in FIG. 12). Balloon 1307 may bedeflated by allowing fluid to exit balloon 1307 through tubing 1201.Deflating balloon 1307 may allow clamp 1202 to compress tubing section1311. Shoulder 1310 may compress a portion of tubing section 1311. Aportion of tubing section 1311 extending through end cap 1309, balloon1307 and tubing 1201 may retain a circular cross section even when clamp1202 is closed.

FIG. 13B shows illustrative apparatus 1302. Apparatus 1302 shows across-section of apparatus 1300 taken along lines 2-2 shown in FIG. 12.Apparatus 1302 shows outer tubing 1201 and inner tubing 1311. Fluid forinflating balloon 1307 may flow in a space between outer tubing 1201 andinner tubing 1311.

Inner tubing 1311 may include a compressible segment and anon-compressible segment. Balloon 1307 may extend along anon-compressible segment of inner tubing 1311. A shoulder 1310 may bepositioned about a compressible segment of inner tubing 1311. Acompressible segment of inner tubing 1311 may be anastomized to conduit1213 (shown in FIG. 12).

DETAILED DESCRIPTION OF THE INVENTION

Apparatus 1302 shows end cap 1309 sealing and end of balloon 1307.Apparatus 1302 shows that end cap 1309 may provide a “seat” forpositioning rotatable arm 1203 relative to an anastomosis site. Further,FIG. 13C shows a magnified partial view of apparatus 1350, which is thesame as apparatus 1302 (shown in FIG. 13B). Apparatus 1350 shows flange1309. The flange 1309 may be circular. The flange 1309 may be configuredto mate with a corresponding indent in the clamp 1203. The mating of theflange 1309 and the indent 1203 may be seen along surface A of flange1309 and the surface B of clamp 1203, with such mating of surface A andsurface B serving to fix a position of the clamp 1203 relative to thelongitudinal axis of the tubing 1201 (shown in FIG. 13A).

FIG. 14 shows illustrative view 1400 of apparatus 1301 (shown in FIG.13A). View 1400 shows a first segment of inner tubing 1311 having atubular diameter of d₁. Inner tubing 1311 may be configured to transportfluid siphoned off from conduit 1213. Diameter d1 may be selected basedon a diameter of d₂ of conduit 1213. Diameter d₁ may be selected toobtain a target throughput of fluid when clamp 1203 is open.

Fluid may be present in a space between outer tubing 1201 and innertubing 1311. The fluid present in the space maybe saline, water or anysuitable fluid for inflating balloon 1307.

FIG. 15A shows illustrative therapeutic scenario 1500. Scenario 1500shows an illustrative anastomization of tubing 1504 to conduit 1519.Conduit 1519 may be a blood vessel. Tubing 1504 may include flared ends1509 and 1511. Flared ends 1509 and 1511 may be anastomized to conduit1519 using sutures 1515 and 1517.

Scenario 1500 shows a portion of a clamp positioned over tubing 1504.The clamp includes rotatable arms 1503 and 1501. Rotatable arm 1503 ispositioned within sleeve 1513. Sleeve 1513 is formed from flared end1511 and outer wall 1505 of tubing 1504. Sleeves may be formed from anysuitable material such as Dacron, Gore-Tex, polytetrafluoroethylene(“PTFE”), fluoropolymer products and any material suitable forimplantation in a human body. Flared end 1511 may include materialsubstantially perpendicular to outer wall 1505 and materialsubstantially parallel to outer wall 1505.

Rotatable arm 1501 is positioned within sleeve 1507. Sleeve 1507 may beformed from flared end 1509 and outer wall 1506 of tubing 1504. Flaredend 1509 may include material substantially perpendicular to outer wall1506 and material substantially parallel to outer wall 1506.

A sleeve may take on different shapes. A sleeve may be constructed witha shape to decrease its footprint in a transverse dimension. Forexample, arms 1501 and 1503 may each be retracted slightly superiorly tothe anastomosis site. Inferior aspects of outer wall 1505 may be fusedto material 1513. Inferior aspects of outer wall 1506 may fused tomaterial 1507. This would allow the device to have a thinner overalltransverse dimension at the anastomotic site but still maintain a tightseal when arms 1501 and 1503 close about tubing 1504.

When the clamp is in an open position, rotatable arms 1503 and 1501 maybe separated by gap G. Gap G may allow a fluid carried by conduit 1519to enter tubing 1504. When the clamp is in a closed position, outerwalls 1505 and 1506 may be compressed to eliminate gap G. Outer walls1505 and 1506 maybe compressed so that flared end 1511 is substantiallyflush with flared end 1509.

FIG. 15B shows illustrative view 1502 taken along line 2-2 shown in FIG.11. View 1502 shows rotatable arms 1103 and 1105 crimping tubing 1111.O-ring 1107 may bias rotatable arms 1103 and 1105 to crimp tubing 1111.The crimping of tubing 1111 may collapse a lumen of tubing 1111. Thecrimping of tubing 1111 may seal tubing 1111 by pressing outer walls oftubing 1111 flush with each other.

Inflating a balloon positioned underneath rotatable arms 1103 and 1105may allow tubing 1111 to expand and reopen a lumen through tubing 1111.

FIG. 16 shows illustrative reservoir 1600. Reservoir 1600 may beimplanted in a human body. Reservoir 1600 includes septum 1611. Septum1611 may include a self-sealing membrane. A needle may penetrate septum1611 to access contents of reservoir 1600. Reservoir 1600 may beimplanted subcutaneously. The needle may penetrate human tissue beforepenetrating septum 1611. Retainer ring 1601 may secure septum 1611 toreservoir 1600.

Fluid may pool in a first chamber of reservoir 1600. The first chambermay be defined, at least in part, by housing 1605. Retainer ring 1601may secure septum 1611 to reservoir 1600 and prevent a leakage ofcontents out of the first chamber.

Reservoir 1600 includes barb 1603. Barb 1603 provides fluidcommunication into housing 1605. Barb 1603 may be inserted into tubing,such as tubing 1101 (shown in FIG. 11). Fluid may be inserted into thefirst chamber via barb 1603. Fluid may be extracted from first chambervia barb 1603.

Fluid may pool in second chamber enclosed, at least in part, by housing1609. The second chamber may not be in fluid communication with firstchamber. A platform (not shown) may fluidly seal the first chamber fromthe second chamber.

Fluid may be inserted into the second chamber via barb 1607. Fluid maybe extracted from the second chamber via barb 1607. Barb 1607 may beinserted into tubing, such as tubing 1201.

FIG. 17 shows exploded view 1700 of reservoir components. View 1700includes retainer ring 1701. Retainer ring 1701 may be positioned overseptum 1703. Retainer ring 1701 may fluidly seal septum 1703 to housing1705. Septum 1703 may be positioned over first housing 1705. Firsthousing 1705 may define, at least in part, a first chamber of areservoir. Fluid contents of the first chamber may be accessed usingbarb 1707.

View 1700 includes platform 1709. Platform 1709 may be moveable.Platform 1709 may translate within housing 1705. Platform 1709 maytranslate within housing 1713. Movement of platform 1709 may expand thefirst chamber. Movement of platform 1709 may contract the secondchamber. Movement of platform 1709 may draw fluid into housing 1705 viabarb 1707. Movement of platform 1709 may expel fluid from housing 1713via barb 1715. Expelling fluid from housing 1713 may induce hydraulicpressure in a tubing connected to barb 1715. The hydraulic pressure maybe directed by the tubing to inflate a balloon affixed to the tubing.

Platform 1709 may be encircled by sealing ring 1711. Sealing ring 1711may prevent housing 1705 from mixing with fluid in housing 1713. Sealingring 711 may fluidly seal a first chamber of the reservoir from a secondchamber of the reservoir.

Platform 1709 includes extension 1712. Extension 1712 may fit into bore1717. Extension 1712 and bore 1717 may center platform 1709 with respectto housing 1713. Extension 1712 and bore 1717 may maintain contactbetween sealing ring 1711 and an inner wall of housing 1713.

Extension 1712 may be configured to translate within bore 1717.Extension 1712 may translate within bore 1717 in response to pressureapplied to platform 1709. For example, a needle that penetrates septum1703 may apply pressure to platform 1709. The pressure may expand afirst chamber of the reservoir and contract a second chamber of thereservoir.

Extension 1712 may translate within bore 1717 in response to pressureexerted by spring 1718. Spring 1718 may bias platform 1709 againstseptum 1703. For example, a needle that penetrates septum 1703 may applypressure to platform 1709. In response to a decrease in pressure appliedto platform 1709 by the needle, platform 1709 may be pushed towardseptum 1703 by spring 1718.

Reservoir 1700 includes bladder 1710. Bladder 1710 may be filled with afluid. The fluid may be water, saline or any suitable fluid. Bladder1710 may be compressible. Bladder 1710 may be compressed by movement ofplatform 1709. Platform 1709 may compress bladder 1710 against a floorand/or inner wall of housing 1713.

Compression of bladder 1710 may expel fluid from bladder 1710. Theexpelled fluid may exit housing 1713 through barb 1715. The expelledfluid may pressurize a tube connected to barb 1715.

Reservoir 1700 includes bushing 1719. Bushing 1719 includes protrusions1721. Protrusions 1721 may be configured to engage guide 1725 in washer1723. Protrusions 1721 may be configured to engage teeth (not shown) inbore 1717. Protrusions 1721 may lock a position of platform 1709 withrespect to septum 1703. Bushing 1719 may be configured to rotate aboutextension 1712.

FIG. 18 shows illustrative view 1800 of reservoir 1700. View 1800includes extension 1712. View 1800 shows bushing 1719. Busing 1719includes protrusion 1721. Housing 1713 includes deep wells 1809 andshallow wells 1811. When protrusion 1721 is seated in a deep well,platform 1709 may be pressed against septum 1703. When protrusion 1721is seated in a shallow well, platform 1709 may compress bladder 1710.

Protrusion 1721 may be moved from a deep well by pressure applied toplatform 1709. For example, a needle inserted through septum 1703 mayapply pressure to platform 1709. In response to the pressure, protrusion1721 may be shifted from a deep well to a shallow well by guide 1725.

FIG. 19 shows illustrative cross-sectional view 1900 taken along lines3-3 shown in FIG. 16. View 1900 includes septum 1611. Septum 1611 may befluidly sealed to housing 1605 by retainer ring 1601.

Platform 1909 may receive a needle inserted through septum 1611 indepression 1925. The needle may push platform 1901 toward floor 1909 ofhousing 1609. Movement of platform 1901 may expand chamber 1923.Movement of platform 1901 may compress bladder 1914 against floor 1923.

Fluid may pool in chamber 1923. Fluid may be prevented from leaking outof chamber 1923 by a seal formed by septum 1611 and retainer 1601.

The fluid in chamber 1923 may include blood that enters chamber 1923from a tubing (not shown) affixed to barb 1603. Barb 1603 may beinserted into a bore in housing 1605. Fluid in chamber 1923 may beprevented from leaking in to housing 1609 by seal 1905. Seal 1905 may besecured by retainer 1907. In some embodiments, platform 1901 may includeretainer 1907.

View 1900 includes bladder 1914. Bladder 1914 may be filled with aliquid. Bladder 1914 may be compressed between platform 1901 and floor1909 of housing 1609.

View 1900 shows extension 1913 of platform 1901. Extension 1913 may beconfigured to fit into bushing 1915. Bushing 1915 may includeprotrusions, such as protrusions 1721 of bushing 1719 (shown in FIG.17). Bushing 1915 may rotate about axis Z when protrusions of bushing1915 are shifted between deep wells and shallow wells of housing 1609.Movement of platform 1901 may shift the protrusions between deep andshallow wells.

In some embodiments, extension 1913 may include a flange. The flange maykeep bushing 1915 fixed longitudinally along axis z with respect toextension 1913. The flange may allow bushing 1915 to rotate about axis Zin response to a shifting of the protrusion between deep and shallowwells.

View 1900 includes washer 1911. Washer 1911 includes guides 1910. Guides1910 align a protrusion of bushing 1915 with a deep or shallow well ofhousing 1609.

When a protrusion of bushing 1915 is positioned in a deep well, bladder1914 may expand to default size. When a protrusion of bushing 1915 ispositioned in a shallow well, bladder 1914 may be compressed. When aprotrusion of bushing 1915 is positioned in a shallow well, platform1901 may be locked in a position that compresses bladder 1914. Pressureapplied to platform 1901 may shift a protrusion of bushing 1915 into adeep well, unlocking platform 1901. When unlocked, a spring or othersuitable biasing member (not shown) may push platform 1901 toward septum1611 and contract chamber 1923.

In some embodiments, prior to unlocking platform 1901, chamber 1923 maybe filled with fluid. The fluid within chamber 1923 may prevent platform1901 from contacting septum 1611. For example, blood may pool in chamber1923. The blood may be extracted from chamber 1923 during a dialysisprocedure. At a conclusion of the dialysis procedure, hepranized salinemay be injected into chamber 1923 and tubing affixed to barb 1603. Thehepranized saline may prevent clots from forming in chamber 1923 and thetubing affixed to barb 1603.

FIG. 20 shows illustrative system 2000. System 2000 includes clamp 2011.System 2000 includes tubing 2009. System 2000 includes adapter 2003.Adapter 2003 includes branch 2005 and branch 2007. Branch 2005 may beaffixed to barb 2006 of reservoir 2001. Branch 2007 may be affixed tobarb 2008 of reservoir 2001.

A needle may be inserted through a septum in reservoir 2001. The needlemay apply pressure to a moveable platform within reservoir 2001 andthereby compress a bladder within reservoir 2001. Compression of thereservoir may expel fluid from the bladder into branch 2007 and tubing2009.

The expelled fluid may inflate a balloon and open clamp 2011. Openingclamp 2011 may open a portion of tubing 2009 anastomized to conduit2013. Opening clamp 2011 may allow blood or other fluid flowing withinconduit 2013 to enter tubing 2009. The blood or other fluid may be drawnfrom conduit 2013 into tubing 2009. The blood or other fluid may flowthrough branch 2005 and into reservoir 2001. The needle may be used toextract the blood or other fluid from reservoir 2001. A system mayinclude one or more of systems 2000.

FIG. 21 shows illustrative apparatus 2100. Apparatus 2100 includes clips2109 and 2107. Clips 2109 and 2107 are affixed to tubing 2111. Apparatus2100 includes clamp 2101. Clamp 2101 includes clips 2103 and 2105. Insome embodiments, tubing 2111 may be anastomized to a conduit. After theanastomization procedure, clamp 2101 may be slipped over tubing 2111 andpositioned relative to the conduit. The clamp may be positioned abuttingthe conduit or near the conduit.

The clamp may be locked in a position relative to the conduit byengagement of clip 2103 of the clamp and clip 2107 of the tubing. Theclamp may be locked in a position relative to the conduit by engagementof clip 2105 of the clamp and clip 2109 of the tubing. Some embodimentsmay only include one set of clips such as clips 2109 and 2105. Someembodiments may include two or more sets of clips.

FIG. 22A shows illustrative apparatus 2200. Apparatus 2200 includespocket 2201. Cantilever arm 2203 may be positioned inside pocket 2201.Pocket 2201 may position cantilever rod 2203 against tubing 2221.Apparatus 2200 includes annular ring 2205. Annular ring 2205 may presscantilever arm 2203 against tubing 2221. Tubing 2221 may include anon-compressible segment underneath annular ring 2205.

Tubing 2221 may include a compressing segment 2219. Pressing cantileverarm 2203 against compressible segment 2219 may close a lumen of tubing2221. Closing the lumen of tubing 2221 may seal tubing 2221 from fluidflowing in conduit 2223.

Cantilever arm 2203 includes angled segment 2202. Angled segment 2202may be fitted into hinges 2213 and 2215. Hinges 2213 and 2215 may beaffixed to panels 2211 and 2209. In some embodiments, panels 2211 and2209 may be inserted into a sleeve affixed to the anastomosis site. Thesleeve may prevent components of apparatus 2200 from contacting bodilytissue. The sleeve may position cantilever arm 2203 and angled segment2202 relative to tubing 2221 and/or conduit 2223.

Apparatus 2200 includes hydraulic tract 2207. Hydraulic tract may carrya hydraulic fluid such as water. Hydraulic tract 2207 may terminate in aballoon segment (not shown). The balloon segment may be inflated byincreasing hydraulic pressure inside hydraulic tract 2207. The balloonsegment may extend between tubing 2221 and annular ring 2205. Theballoon segment may extend alongside tubing 2221 from annular ring 2205to a junction of cantilever arm 2203 and angled segment 2202.

When the balloon segment is inflated, cantilever arm 2203 may pushangled segment 2202 away from tubing 2221. Angled segment 2202 move awayfrom tubing 2221 by rotating panels 2211 and 2209 about hinges 2213,2215, 2225, 2227, 2229 and 2231. Pushing angled segment 2202 away fromtubing 2221 may open a lumen in tubing 2221 placing tubing 2221 in fluidcommunication with contents of conduit 2223. Apparatus 2200 may includetwo or more cantilever arms and associated angled segments.

FIG. 22B shows an illustrative cross-section of apparatus 2200 takenalong lines 4-4 when balloon segment 2235 is in a deflated state. FIG.22C shows an illustrative cross-section of apparatus 2200 taken alonglines 4-4 when the balloon segment 2235 is in an inflated state.

FIGS. 23A-23B show illustrative process 2300. For the sake ofillustration, one or more of the steps of the process illustrated inFIG. 23 will be described as being performed by a “system.” The “system”may include one or more of the features of the apparatus, arrangementsinformation or processes shown in FIGS. 1-22 and/or any other suitabledevice or approach.

The “system” may be a computer or robotic system. For example, asubcutaneous reservoir may include circuitry for directing a roboticallycontrolled needle into a septum of the reservoir. The system may provideautomated dialysis of a patient's blood.

Process 2300 begins at step 2301. At step 2301, the system inserts aneedle into septum of a first reservoir coupled to an artery of apatient. At step 2303, the system expands a first chamber of the firstreservoir and contracts a second chamber of the first reservoir bypressing the needle against a moveable platform between the firstchamber and the second chamber.

At step 2305, hydraulic pressure is generated by compressing themoveable platform against a liquid filled bladder within the secondchamber. At step 2307, the system continues to press the needle againstthe moveable platform until the moveable platform locks in positioncompressing the bladder. At step 2309, the hydraulic pressure opens aclamp that is biased to compress a resilient segment of tubinganastomized to the blood vessel.

At step 2311, blood begins to flow from the blood vessel into the firstchamber. At step 2313, using needle, the system extracts blood from thefirst chamber. At step 2315, the system transfers the blood extractedfrom the first chamber to a dialysis machine. At step 2317, the systemfilters the extracted blood. At step 2319, the system transfers thefiltered blood to a second reservoir. The first and second reservoir maybe coupled to arteries, veins or any suitable combination of bloodvessels. At step 2321, the system returns the filtered blood tocirculation within the patient via hydraulically controlled accesscoupled to the second reservoir.

At step 2321, the system presses a needle against the moveable platformto further expand the first chamber of the first reservoir and furthercontract the second chamber of the first reservoir thereby unlocking themoveable platform. At step 2323, a biasing member of the reservoircollapses the first chamber of the reservoir. At step 2325, as a resultof the expansion that second chamber, the bladder fills with fluid anddecreases the hydraulic pressure allowing the balloon to deflate. Atstep 2327, the clamp closes upon a resilient segment of tubing therebysealing the blood vessel from the graft. The clamp may be positioned toseal the tubing in a manner that preserves substantially uniform bloodflow through the blood vessel across the site of the anastomization atstep 2329.

Apparatus and methods described herein are illustrative. Apparatus andmethods of the invention may involve some or all of the features of theillustrative apparatus and/or some or all of the steps of theillustrative methods. The steps of the methods may be performed in anorder other than the order shown and described herein. Some embodimentsof the invention may omit steps shown and described in connection withthe illustrative methods. Some embodiments of the invention may includesteps that are not shown and described in connection with theillustrative methods.

The invention may be operational with numerous other general purpose orspecial purpose computing system environments or configurations. Forexample, control of expandable, contractible and otherwise moveableapparatus may be controlled by a computer system. Examples of well-knowncomputing systems, environments, and/or configurations that may besuitable for use with the invention include, but are not limited to,personal computers, server computers, hand-held or laptop devices,mobile phones and/or other personal digital assistants (“PDAs”),multiprocessor systems, microprocessor-based systems, set top boxes,programmable consumer electronics, network PCs, minicomputers, mainframecomputers, distributed computing environments that include any of theabove systems or devices, and the like. In a distributed computingenvironment, devices that perform the same or similar function may beviewed as being part of a “module” even if the devices are separate(whether local or remote) from each other.

The invention may be described in the general context ofcomputer-executable instructions, such as program modules, beingexecuted by a computer. Generally, program modules may include routines,programs, objects, components, data structures, etc., that performparticular tasks or store or process data structures, objects and otherdata types. The invention may also be practiced in distributed computingenvironments where tasks are performed by separate (local or remote)processing devices that are linked through a communications network. Ina distributed computing environment, program modules may be located inboth local and remote computer storage media including memory storagedevices.

Although the invention has been described in terms of particularembodiments and applications, one of ordinary skill in the art, in lightof this teaching, can generate additional embodiments and modificationswithout departing from the spirit of or exceeding the scope of theprinciples of the invention. Accordingly, it is to be understood thatthe drawings and descriptions herein are proffered by way of example tofacilitate comprehension of the invention and should not be construed tolimit the scope thereof. Persons skilled in the art will appreciate thatthe present invention can be practiced by other than the describedembodiments, which are presented for purposes of illustration ratherthan of limitation.

Thus, systems and methods for hydraulically controlled arterial/venousaccess have been provided. Persons skilled in the art will appreciatethat the present invention can be practiced by other than the describedembodiments, which are presented for purposes of illustration ratherthan of limitation. The present invention is limited only by the claimsthat follow.

What is claimed is:
 1. A graft comprising: a first tubing configured tobe anastomized to a blood vessel, the first tubing comprising acompressible portion and a non-compressible portion; a second tubingcomprising inflatable material encircling the first tubing; and a plugencircling the first tubing and sealing fluid within the second tubing;a clamp rotatable about a pivot and biased to crimp the compressibleportion of the first tubing; and a balloon that, when inflated about thenon-compressible portion of the first tubing, rotates the clamp aboutthe pivot and releases the clamp from the compressible portion of thefirst tubing.
 2. The graft of claim 1, the plug further comprising acircular flange that is configured to mate with a corresponding circularindent in the clamp, thereby maintaining a position of the clamprelative to the blood vessel.